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Published on: May 2, 2018
A correlation study between virulence factors and multidrug resistance among clinical isolates of Proteus mirabilis
Mai Elhoshi1, Eglal El-Sherbiny1, Amel Elsheredy1
1Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt.
Abstract:
Treatment of Proteus mirabilis infections is a challenge due to the high abundance of virulence factors and the high intrinsic resistance to antimicrobials. Multidrug resistance (MDR) and extensive drug resistance (XDR) further challenge the control of P. mirabilis infection. This study aimed to investigate the correlation between virulence determinants and multidrug resistance in 100 clinical isolates of P. mirabilis collected in Alexandria from December 2019 to June 2021. Susceptibility to antimicrobials was tested by the Kirby Bauer method. Detection of swarming, urease, protease, hemolysin, and biofilm formation was performed phenotypically and by PCR amplification of zapA, flaA, ureC, mrpA, atfA, ucaA, hpmA, and luxS. MDR and XDR were detected in 34% and 5%, respectively. All isolates were positive for motility, swarming, urease, and protease production. Ninety percent were positive for hemolysin production, while 73% formed biofilm. All isolates possessed the ureC and zapA genes. The luxS, flaA, ucaA, hpmA, mrpA, and atfA genes were detected in 99%, 98%, 96% 90%, 89%, and 84%, respectively. The presence of a single biofilm-related gene was statistically correlated with non-biofilm production (P= 0.018). It was concluded that P. mirabilis isolates from catheterized-urine samples were significantly associated with biofilm formation. MDR and virulence were not statistically correlated. A significant positive correlation was detected between some virulence genes in P. mirabilis. Non-MDR isolates of P. mirabilis had a high abundance of virulence factors with no statistically significant difference from MDR. Most of the MDR and all XDR isolates could produce biofilm.
Insights
Proteus mirabilis infections are difficult to treat due to drug resistance and virulence factors. This study found no direct link between multidrug resistance (MDR) and virulence in clinical isolates, though biofilm formation was common.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Proteus mirabilis infections pose treatment challenges due to high virulence and antimicrobial resistance.
- Multidrug resistance (MDR) and extensive drug resistance (XDR) complicate P. mirabilis infection control.
- Understanding the relationship between virulence and resistance is crucial for effective treatment strategies.
Purpose of the Study:
- To investigate the correlation between virulence determinants and multidrug resistance in clinical P. mirabilis isolates.
- To analyze the prevalence of specific virulence factors and antimicrobial resistance patterns.
- To determine the association between biofilm formation and antimicrobial resistance.
Main Methods:
- Collected 100 clinical P. mirabilis isolates from Alexandria (December 2019 - June 2021).
- Assessed antimicrobial susceptibility using the Kirby Bauer method.
- Detected virulence factors (swarming, urease, protease, hemolysin, biofilm) phenotypically and via PCR for specific genes (zapA, flaA, ureC, mrpA, atfA, ucaA, hpmA, luxS).
Main Results:
- MDR and XDR were observed in 34% and 5% of isolates, respectively.
- All isolates exhibited motility, swarming, urease, and protease production; 90% produced hemolysin, and 73% formed biofilms.
- While virulence genes were highly prevalent, MDR and overall virulence showed no statistical correlation. Biofilm production was linked to catheterized-urine isolates and common in MDR/XDR strains.
Conclusions:
- P. mirabilis isolates from catheterized-urine samples demonstrate a significant association with biofilm formation.
- No statistical correlation was found between multidrug resistance and virulence factors in this study.
- Despite high virulence factor abundance in non-MDR isolates, no significant difference was observed compared to MDR isolates.
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