Prevalence of Virulence Genes and Antibiotic Resistance in Clinical Isolates of Proteus mirabilis

ORIGINAL ARTICLE
Marwa Shaker Mahmood, Mustafa S. AL-Salmani, Shahad Basil Ismael, Ahmed Sami AL-Salmany, Aws Akram Jumaah, Hasan A. Aal Owaif

 
For citation: Mahmood MS, AL-Salmani MS, Ismael SB, AL-Salmany AS, Jumaah AA, Aal Owaif HA. Prevalence of Virulence Genes and Antibiotic Resistance in Clinical Isolates of Proteus mirabilis. International Journal of Biomedicine. 2025;15(2):400-403. doi:10.21103/Article15(2)_OA22
 
Originally published June 5, 2025
 

Abstract: 

Background: Proteus mirabilis can be distributed in water, soil, and the human digestive tract. It is considered among the leading causes of urinary tract infections and can also cause bacteremia, as well as wound and respiratory infections. This study aimed to determine the antibiotic resistance profile and the number of virulence genes in local P. mirabilis isolates from various clinical samples.
Methods and Results: Between May 2024 and August 2024, a total of 250 samples were collected from various clinical sources, including wound swabs, sputum, urine, and pus, at different hospitals in Baghdad. To identify P. mirabilis isolates, biochemical tests and the VITEK 2 system were used. An antibiotic susceptibility test was performed using the disc diffusion technique. The zapA, ureC, mrpA, and rsbA genes were detected by PCR.
Seventy-three (29.2%) isolates out of 250 samples from different sources were identified as P. mirabilis. The results indicated that 73.6%, 29.3%, 6.2%, and 17.6% of pus, wound, sputum, and urine samples, respectively, were P. mirabilis. Of the isolates, 95.9% were resistant to nitrofurantoin, 75.3% to aztreonam, 91.8% to ampicillin, 67.1% to levofloxacin, 58.9% to ceftazidime, 52.1% to piperacillin, 27.4% to ciprofloxacin,11.0% to imipenem, and 9.6% to amikacin. The rate of zapA, ureC, mrpA, and rsbA genes was 75.3%, 91.7%, 52.1%, and 79.4%, respectively.
Conclusion: This study showed that P. mirabilis is commonly found in sputum, urine, wounds, and pus samples, and that infections are more prevalent in men. It exhibits significant levels of antibiotic resistance, especially to nitrofurantoin (95.9%). The need for efficient infection control and antimicrobial stewardship to address multidrug-resistant P. mirabilis infections is highlighted by the rising antibiotic resistance, which has been linked to changes in bacterial enzymes and antibiotic misuse.

Keywords: 
Proteus mirabilis • antibiotic resistance • virulence genes
References: 
  1. Salama LA, Saleh HH, Abdel-Rhman SH, Barwa R, Hassan R. Assessment of typing methods, virulence genes profile and antimicrobial susceptibility for clinical isolates of Proteus mirabilis. Ann Clin Microbiol Antimicrob. 2025 Jan 15;24(1):4. doi: 10.1186/s12941-024-00770-8. PMID: 39815271; PMCID: PMC11734338.
  2. Algammal AM, Hashem HR, Alfifi KJ, Hetta HF, Sheraba NS, Ramadan H, El-Tarabili RM. atpD gene sequencing, multidrug resistance traits, virulence-determinants, and antimicrobial resistance genes of emerging XDR and MDR-Proteus mirabilis. Sci Rep. 2021 May 4;11(1):9476. doi: 10.1038/s41598-021-88861-w. PMID: 33947875; PMCID: PMC8096940.
  3. Chakkour M, Hammoud Z, Farhat S, El Roz A, Ezzeddine Z, Ghssein G. Overview of Proteus mirabilis pathogenicity and virulence. Insights into the role of metals. Front Microbiol. 2024 Apr 5;15:1383618. doi: 10.3389/fmicb.2024.1383618. PMID: 38646633; PMCID: PMC11026637.
  4. Hussein EI, Al-Batayneh K, Masadeh MM, Dahadhah FW, Al Zoubi MS, Aljabali AA, Alzoubi KH. Assessment of Pathogenic Potential, Virulent Genes Profile, and Antibiotic Susceptibility of Proteus mirabilis from Urinary Tract Infection. Int J Microbiol. 2020 Feb 7;2020:1231807. doi: 10.1155/2020/1231807. PMID: 32089693; PMCID: PMC7029293.
  5. Aal Owaif HA, Mhawesh AA, Abdulateef SA. The role of BipA in the regulation of K1 capsular polysaccharide production of uropathogenic Escherichia coli. Ann Trop Med Public Health. 2019;22 (Special Issue):S254. doi: 10.36295/ASRO.2019.220924.
  6. Yuan F, Huang Z, Yang T, Wang G, Li P, Yang B, Li J. Pathogenesis of Proteus mirabilis in Catheter-Associated Urinary Tract Infections. Urol Int. 2021;105(5-6):354-361. doi: 10.1159/000514097. Epub 2021 Mar 10. PMID: 33691318.
  7. Sabih A, Leslie SW. Complicated Urinary Tract Infections. 2024 Dec 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 28613784.
  8. Mhawesh A, Aal Owaif HA, Abdulateef S. In vitro experimental research for using the silver nanoparticles as plasmid curing agent in some types of multi-antibiotic resistant pathogenic bacteria. Indian J Public Health Res Dev.2019;10(8):2448–54. doi: 10.5958/0976-5506.2019. 02233.2.
  9. Owaif HAA, Aldulaimy MK, Abdulateef SA. The Antibiotic Resistance Genes blaSHV, blaOXA-48, blaTEM and blaIMP in Pseudomonas aeruginosa Isolated from Respiratory Tract Infections in Baghdad, Iraq. International Journal of Biomedicine.2023;13(4):341-344. doi:10.21103/Article13(4) _OA18.
  10. Umar M, Arzai A, Yusuf G, et al. Serological characterization and antimicrobial sensitivity profile of Haemophilus influenzae serotypes isolated from Aminu Kano Teaching Hospital, Kano, Nigeria. Brit Microbiol Res J. 2016;15(5):1–10.
  11. Al-Mayahi FSA. Phenotypic and molecular detection of virulence factors in Proteus mirabilis isolated from different clinical sources. Bas Vet Res J. 2017;16(1):369.
  12. Al-Dulaymi AAA-M, Aal Owaif HA. Overexpression of lasB gene in Klebsiella pneumoniae and its effect on biofilm formation and antibiotic resistance. Al-Rafidain J Med Sci. 2024;6(2):3–8. doi:10.54133/ajms.v6i2.668.
  13. Ali HH, Yousif MG. Detection of some virulence factors genes of Proteus mirabilis isolated from urinary tract infection. Int J Adv Res. 2015;3(1):156–63.
  14. Kamil SA, Aldahhan HAA. Molecular detection of some virulence genes of Proteus mirabilis in rheumatoid arthritis patient’s urine and other clinical samples: Comparative study. Int J Health Sci. 2022;6(S4):3534–43. doi:10.53730/ijhs.v6nS4.9835.
  15. Tabatabaei A, Ahmadi K, Shabestari AN, Khosravi N, Badamchi A. Virulence genes and antimicrobial resistance pattern in Proteus mirabilis strains isolated from patients attended with urinary infections to Tertiary Hospitals, in Iran. Afr Health Sci. 2021 Dec;21(4):1677-1684. doi: 10.4314/ahs.v21i4.22. PMID: 35283944; PMCID: PMC8889823.
  16. Al-Khalidy RMS, Aburesha RA. Molecular detection of some virulence genes in Proteus mirabilis isolated from urinary tract infection in Iraq. Iraqi J Agric Sci. 2023;54(3):709–15. doi: 10.36103/ijas.v54i3.1751.
  17. Bahashwan SA, El-Shafey MH. Antimicrobial resistance patterns of Proteus isolates from clinical specimens. Eur Sci J. 2013;9:188–202.
  18. Serry FM, Abdel-Latif HK, Gomaa SE, Abbas HA. Antimicrobial resistance of clinical Proteus mirabilis isolated from different sources. Zagazig J Pharm Sci. 2018;27(1):57–63. doi:10.21608/zjps.2018.38156.
  19. Priya PS, Manonmoney, Leela KV. Phenotypic characterization of Proteus species isolated from different clinical samples with special reference to antibiotic resistance pattern in a tertiary care centre. J Clin Diagn Res. 2022;16(1):DC15-19.doi: 10.7860/JCDR/2022/51928. 15901.
  20. Elhoshi M, El-Sherbiny E, Elsheredy A, Aboulela AG. A correlation study between virulence factors and multidrug resistance among clinical isolates of Proteus mirabilis. Braz J Microbiol. 2023 Sep;54(3):1387-1397. doi: 10.1007/s42770-023-01080-5. Epub 2023 Aug 3. PMID: 37535261; PMCID: PMC10484824.
  21. Kamil TD, Jarjes SF. Isolation, identification, and antibiotics susceptibility determination of Proteus species obtained from various clinical specimens in Erbil City. Polytechnic Journal. 2019;9(2):Article 15. doi:10.25156 /ptj.v9n2y2019.pp86-92.
  22. Dias SP, Brouwer MC, van de Beek D. Sex and Gender Differences in Bacterial Infections. Infect Immun. 2022 Oct 20;90(10):e0028322. doi: 10.1128/iai.00283-22. Epub 2022 Sep 19. PMID: 36121220; PMCID: PMC9584217.
  23. Hussein MH, Aal Owaif HA, Abdulateef SA. The Aminoglycoside Resistance Genes, pehX, blaCTX-M, blaAmpC, and npsB among Klebsiella oxytoca Stool Samples. International Journal of Biomedicine. 2023;13(3):127-130. doi:10.21103/Article13(3)_OA13.
  24. Abdulateef SA, Al-Salmani MS, Aal Owaif HA. Acinetobacter baumannii producing ESBLs and carbapenemases in the Intensive Care Units developing fosfomycin and colistin resistance. J Appl Nat Sci. 2023;15(3):1263-1267. doi:10.31018/jans.v15i3. 4872.
  25. Phiri RM, Ertuğrul MB, Bozdoğan B, Hoşbul T. Evaluation of virulence genes in Proteus strains isolated from diabetic foot infections and urinary tract infections. J Infect Dev Ctries. 2024 Oct 31;18(10):1559-1565. doi: 10.3855/jidc.18928. PMID: 39616486.

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Received March 25, 2025.
Accepted May 19, 2025.
©2025 International Medical Research and Development Corporation.