It is likely that this is because of a lower number of Clone D isolates in the more recent collection and that these RODs were largely associated with Clone D specifically, rather than a general features of the cluster. The exception was ROD16. However, the similar prevalence of this ROD amongst blood culture isolates of P. aeruginosasuggests that ROD16 is not a particular feature of keratitis-associated isolates. Previously

identified characteristics associated with the core keratitis cluster (Stewart et al., 2011) were confirmed in the current study. The keratitis-specific subpopulation strains carry the oriC1 allele, exoU, and a truncated version of the flagellin glycosylation island, but are less likely to carry the gene encoding the nonhaem catalase KatN. As previously noted, carriage of the exoU gene was significantly associated with the oriC1 allele (Stewart et al., 2011). Roxadustat mw The AT genotyping scheme has also been used to analyse strains from diverse backgrounds, indicating the presence of dominant clones that are widely distributed (Wiehlmann et al., 2007a, b). A recent study using AT typing reported the presence of several extended clonal complexes (ecc) that were nonuniformly distributed in freshwater sources of varying water quality, suggesting that the population dynamics of P. aeruginosa may be shaped by environmental rather than clinical factors (Selezska et al., 2012). Isolates of the cladogenically divergent eccB

were the most

frequently sampled from various environmental water sources, prompting Selleck CH5424802 the suggestion that this clonal complex represents a ‘water ecotype’ better adapted to environmental water than other P. aeruginosa (Selezska et al., 2012). Interestingly, an exoU+/exoS− genotype is a feature within this eccB group. In our study, we found that the core keratitis cluster includes HER2 inhibitor clone types (such as A, B, D and I) that are eccB clone types (Selezska et al., 2012). The eccB group also includes serotypes O11, O10 and O8 (Selezska et al., 2012) which feature prominently amongst the core keratitis cluster (Stewart et al., 2011). For 78 isolates, we had clinical data regarding the use of contact lenses. Although the differences were not statistically significant, a greater proportion of core keratitis cluster isolates were associated with contact lens use (72%, 56 of 78) than for isolates not within the core cluster (28%, 22 of 78). A larger sample size would be needed to test whether this association is significant. Our observations suggest that there is a sub-set of P. aeruginosa isolates that are associated with bacterial keratitis in the UK, remain relatively stable over time, and are related to the eccB clonal complex associated with adaptation to survival in environmental water (Selezska et al., 2012). This is consistent with the notion that aquatic environments are integral to the transmission dynamics of P. aeruginosa in the context of bacterial keratitis.