ArticleBMC infectious diseases2026
Assessment of genetic determinants of virulence and fluoroquinolone resistance in Proteus mirabilis isolates from urinary tract infections in Egypt.
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Abstract
backgroundProteus mirabilis (P. mirabilis) is a leading cause of urinary tract infections (UTIs) in both community and healthcare settings, especially in catheterized patients. Proteus species express various types of fimbriae that can serve as colonization-related virulence factors. The severity of infection escalates when these virulent strains acquire antibiotic resistance. The aim of this study was to investigate the prevalence, antimicrobial susceptibility, and genetic determinants of fluoroquinolone resistance in P. mirabilis isolates. Further, to screen for the presence of virulence genes encoding fimbriae and integrons.
methodsA total of 103 P. mirabilis isolates were recovered from urine samples collected from catheterized and non-catheterized UTI patients at Minia University Hospitals, Egypt. Antimicrobial susceptibility of fluoroquinolone-resistant (FQR) isolates was evaluated using the disc diffusion method. Phenotypic detection of extended-spectrum β-lactamase (ESBL) production was then performed, followed by molecular analysis for ESBL and plasmid-mediated quinolone resistance (PMQR) genes within the FQR isolates. All P. mirabilis isolates were screened by PCR for four virulence genes encoding fimbriae. Additionally, class 1, 2, and 3 integrons were investigated.
resultsAmong the 103 P. mirabilis isolates, 47 (45.6%) were non-susceptible to ciprofloxacin, of which 22 exhibited intermediate non-susceptibility and 25 were resistant. Multidrug resistance (MDR) was found in 70.2% (33/47) of FQR isolates, with significantly higher resistance to amoxicillin-clavulanic acid, sulfamethoxazole-trimethoprim, gentamicin, and amikacin compared to fluoroquinolone susceptible isolates. The virulence genes pmfA and mrpA were detected in 86.4% (89/103) and 78.6% (81/103) of isolates, respectively, while both atfA and ucaA were present in 70.9%. Isolates from catheterized patients showed significantly higher prevalence of virulence genes compared to those from non-catheterized individuals. PMQR genes were detected in 91.5% (43/47) of FQR isolates. The most prevalent were qnrS (74.5%), aac(6')-Ib-cr and qnrA (66% each), followed by qnrC (42.6%), qnrB (31.9%), and qepA (8.5%). Co-carriage of multiple PMQR genes was significantly more frequent in isolates with ciprofloxacin resistance than in those with intermediate non-susceptible (p = 0.0001). ESBL genes were detected in 36.8% of ESBL-producing FQR isolates, with bla
conclusionOur findings reveal a significantly high prevalence of fimbriae-associated virulence genes in P. mirabilis isolates from catheterized UTI inpatients, alongside notable dissemination of PMQR genes and class 1 integrons. The coexistence of these virulence and resistance determinants, particularly in hospital-derived strains, is concerning, as it may enhance horizontal gene transfer. This combination contributes significantly to MDR strain persistence and dissemination in the clinical settings.
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