<p>Characterization of Antibiotic-Susceptibility Patterns, Virulence Factor Profiles and Clonal Relatedness in <em>Proteus mirabilis</em> Isolates from Patients with Urinary Tract Infection in Iran</p>

Abstract

Purpose: Proteus mirabilis is one of the most important agents of urinary tract infection (UTI). As there are limited data abou the pathogenicity P. mirabilis isolated from Iran, we investigated the virulence characteristics and antibiotic resistance in the isolates. Finally, the genotypic patterns were evaluated by Pulse field gel electrophoresis (PFGE). Methods: A total of 110 isolates of P. mirabilis causing UTIs were isolated from patients in Tehran, Iran. The virulence characteristics and antimicrobial susceptibility were assayed using phenotypic methods. Extended-spectrum β-lactamases (ESBLs) production was assayed by the combination disk diffusion test (CDDT). Presence of virulence genes and antimicrobial-resistant genes was detected by Polymerase chain reaction (PCR). Finally, thirty-three isolates were selected for PFGE. Results: All isolates showed the ability of biofilm and hemolysin formation. Antibiotic resistance ranged from 59.1% about cotrimoxazole to 2.7% about amoxicillin-clavulanic acid. Sixteen (14.5%) of the isolates were classified as multi-drug resistant (MDR). All isolates amplified mrpH, mrpA, pmfA, ureG and hpmA genes. Furthermore, the prevalence of zapA, fliC, ptaA, and ucaA genes was 98.2%, 98.2%, 95.5%, and 95.5%, respectively. The prevalence of plasmidmediated quinolone resistance (PMQR) genes was 4.5% and 0.9% for aac(6ʹ)-Ib-cr and qnrA, respectively. Twenty-eight pulsotypes were detected among the 33 isolates by PFGE that pulsotypes 1, 2 and 4 with two isolates and pulsotype 3 with three isolates were the most prevalent ones. Conclusion: It was found that the P. mirabilis isolates had high frequency of virulence factors. In addition, antibiotic resistance to some antibiotics and also production of ESBLs is alarming and shows the need for hygienic procedures to prevent the dissemination of antibiotic resistance. Although PFGE showed genetic diversity among the isolates, finding of several pulsotypes among the isolates should be considered an alarm to prevent these infections in hospital environments.

Virulence, resistance and clonality of Proteus mirabilis isolated from patients with community-acquired urinary tract infection (CA-UTI) in Brazil

“…In this study, virulence, resistance to antimicrobials, and clonal diversity of 183 strains of P. mirabilis isolated from the urine of UTI patients assisted by basic health units in Londrina, Brazil, were evaluated. P. mirabilis is known to be an important pathogen that is related to about 1–10% of these infections [ 23 ].…”

“…The prevalence of UTIs among male children (especially up to 1 year of age) varies among different populations, probably due to factors such as circumcision, which has been associated with a reduction of the risk of UTIs [ 17 ]. In this context, it is important to mention that UTI caused by P. mirabilis is more prevalent in patients with structural abnormalities of the urinary tract [ 23 ]. In addition, it is known that children with urinary tract malformations have a reduced number of E. coli infections and a greater number of infections caused by other Gram-negative microorganisms [ 27 ].…”

“…P. mirabilis is among the most common pathogens of urinary tract infection; cystitis and acute pyelonephritis are common types of UTI caused by this species. The severity of UTI caused by P. mirabilis depends on the expression of several virulence factors, biofilm formation ability, and resistance to the different classes of antimicrobials used against these pathogens [ 23 ]. Our results indicate a high prevalence of virulence factors among the studied isolates [ 23 ].…”

“…The severity of UTI caused by P. mirabilis depends on the expression of several virulence factors, biofilm formation ability, and resistance to the different classes of antimicrobials used against these pathogens [ 23 ]. Our results indicate a high prevalence of virulence factors among the studied isolates [ 23 ]. conducted a study on the virulence profile of P. mirabilis strains isolated from patients with UTI and found that 100% of the strains were positive for the mrpA , pmfA, and hmpA genes, whereas the zapA , ptA, and ucaA genes were found in 98.2%, 95.5%, and 95.5% of the strains, respectively [ 15 ].…”

Pathogenic Factors Correlate With Antimicrobial Resistance Among Clinical Proteus mirabilis Strains

“…Over the past decades, clinical strains of P. mirabilis, just like other Enterobacterales, have become increasingly resistant to antimicrobials, which is a serious problem for hospitalized patients (Baraniak et al, 2016;Köck et al, 2018;Literacka et al, 2019;Mirzaei et al, 2019). In some countries, strains with extended-spectrum β-lactamases (ESBLs) or AmpC-like cephalosporinases have spread, which, apart from resistance to penicillins and cephalosporins (including oxyiminocompounds), display broad resistance to other anti-infectives (D'Andrea et al, 2011;Izdebski et al, 2013;Adler et al, 2016;Brolund et al, 2019;Literacka et al, 2019).…”