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

Abstract

Urinary tract infections (UTIs) are among the most common human infections, both in hospitals and in communities. Proteus mirabilis is known to cause community-acquired urinary tract infection (CA-UTI) and is an important causative agent of nosocomial UTIs. The pathogenesis of this species is related to its ability to manifest virulence factors, such as biofilms, adhesion molecules, urease, proteases, siderophores, and toxins. In this study, we investigated the virulence, sensitivity to antimicrobials, and clonal relationship of 183 strains isolated from the urine of CA-UTI patients in Londrina, Paraná State, Brazil. A total of 100% of the strains were positive for hpmA, ptA, zapA, mrpA, pmfA, ireA, and atfA virulence genes. The ucaA gene was positive in 81.4% of the cases. The strains showed high rates of sensitivity to the evaluated antimicrobials, and only one was ESBL-positive. All the tested bacteria showed the capacity to form biofilms: 73.2% had a very strong intensity, while 25.7% had a strong intensity, and 1.1% had a moderate intensity. Regarding clonality, 40 clonal clusters were found among the microorganisms tested. Our results showed that strains of P. mirabilis isolated from CA-UTI patients have several virulence factors. Although the urinary clinical isolates studied showed high sensitivity to antimicrobials, the strains showed a strong capacity to form biofilms, making antibiotic therapy difficult. In addition, it was observed that there were clones of P. mirabilis circulating in the city of Londrina.

From the Urinary Catheter to the Prevalence of Three Classes of Integrons, β-Lactamase Genes, and Differences in Antimicrobial Susceptibility of Proteus mirabilis and Clonal Relatedness with Rep-PCR

“…In this study, we evaluated the molecular characteristics of P. mirabilis isolated from CAUTI. The result of the current study showed that all of the isolates had the ability of biofilm formation, being in line with other studies [ 30 , 35 ]. The severity of biofilm formation depends on the day of catheterization.…”

Coexistence of integrons class 1 and 2 with emergence of class 3 among Proteus mirabilis clinical isolates from Alexandria, Egypt

“…Similarly, a previous recent study in Egypt indicated 64.5% resistance to ampicillin, but a lower resistance rate (19.4%) to trimethoprim-sulfamethoxazole [11]. Our results are in accordance with previous studies from different parts of the world that also reported high resistance rate to these two antibiotics [5,[31][32][33]. This might be explained by the extensive misuse of these drugs in the treatment of UTIs.…”

“…The percentage of MDR in P. mirabilis reported varied among studies. Although a higher percentage of MDR was stated in Mirzaei et al [21] and Alabi et al [31] (82.5% and 55.6% respectively), Oliveira et al [32] and Mirzaei et al [33] reported a lower multidrug resistance percentage of 7.1% and 14.5% respectively. These discrepancies might be related to variances in in the sources of samples and regional differences in the abundance of bacterial strains and variable standards and controls for antibiotic prescription and use.…”

Phenotypic and genotypic characterization of Extended Spectrum β-lactamases producing Proteus mirabilis isolates.

“…Resemble results of (Danilo de Oliveira et al, 2021); showing that the highest resistance rate was found to trimethoprim/ sulfamethoxazole combination. A study performed by (Gravey et al, 2017) showed different resistance rates for gentamicin (18%), phosphomycin (19%), ciprofloxacin (21%), norfloxacin (22%), nalidixic acid (26%), trimethoprim/ sulfamethoxazole (32%), ampicillin and amoxicillin (40%), and ticarcillin (42%) (Gravey et al, 2017).…”