Clinical Specimens are the Pool of Multidrug- resistant Pseudomonas aeruginosa Harbouring oprL and toxA Virulence Genes: Findings from a Tertiary Hospital of Nepal.

The multidrug- or extensively drug-resistant (MDR/XDR) carrying some virulence genes has become a global public health threat. However, in Nepal, there is no existing report showing the prevalence of and virulence genes among the clinical isolates of . . Therefore, this study was conducted for the first time in the country to detect the virulence genes ( and ) and antibiotic susceptibility pattern of . . A total of 7,898 clinical specimens were investigated following the standard microbiological procedures. The antibiotic susceptibility testing was examined by the modified disc diffusion method, and virulence genes and of . were assessed using multiplex PCR. Among the analyzed specimens, 87 isolates were identified to be . of which 38 (43.68%) isolates were reported as MDR. A higher ratio of . was detected from urine samples 40 (45.98%), outpatients' specimens 63 (72.4%), and in patients of the age group of 60-79 years 36 (41.37%). . was more prevalent in males 56 (64.36%) than in female patients 31 (35.63%). Polymyxin (83.90%) was the most effective antibiotic. (100%) isolates harboured the gene, while 95.4% of isolates were positive for the gene. Identification of virulence genes such as and carrying isolates along with the multidrug resistance warrants the need for strategic interventions to prevent the emergence and spread of antimicrobial resistance (AMR). The findings could assist in increasing awareness about antibiotic resistance and suggest the judicious prescription of antibiotics to treat the patients in clinical settings of Nepal.