P. aeruginosa KU-2 was the only P. aeruginosa strain isolated from this patient's clinical specimens. He was treated with norfloxacin. Repeated urine cultures did not yield any organism, and he was discharged 15 days later. He had no history of travel outside Kuwait. Dashed lines indicate identical amino acids.
Arrow indicates position of the putative cleavage site of the peptide leader.
As assessed by antibiotic susceptibility testing by disc diffusion, plasmid pROT-1 conferred additional resistance to gentamicin, netilmicin, sulfonamides, and tobramycin. Although the patients had not traveled outside Kuwait, introduction of P. aeruginosa into Kuwaiti hospitals by travelers or patients from Southeast Asia cannot be ruled out. ESBLs in P. aeruginosa in Kuwait and other Middle Eastern hospitals may be underestimated because routine detection with a double disc synergy test may be difficult. Identification of ESBLs is of interest since they confer resistance to all extended-spectrum cephalosporins and aztreonam, whatever their MICs. This work underscores that very similar ESBLs may be identified in different parts of the world.