Proteus species bloodstream infections: Comparative epidemiology of three species.

BACKGROUND: Although Proteus species are occasional causes of serious infections, their epidemiology has not been well defined. The objective was to describe the overall and species-specific occurrence and determinants of Proteus species bloodstream infection (BSI) in a large Australian population. METHODS: All Queensland residents with Proteus species BSI identified within the publicly funded healthcare system between 2000 and 2019 were included. RESULTS: A total of 2,143 incident episodes of Proteus species BSI were identified among 2,079 Queensland residents. The prevalence of comorbid illness differed with higher Charlson comorbidity scores observed with P. penneri and P. vulgaris, and higher prevalence of liver disease with P. penneri, higher comorbid cancer with P. vulgaris, and lower diabetes and renal disease prevalence with P. mirabilis BSIs. CONCLUSION: This study provides novel information on the epidemiology of Proteus species BSI.

Bacteriological Study of Urinary Tract Infections among Pregnant Women in Al Samawa City of Iraq.

Pregnancy causes some changes in pregnant women due to mechanical and hormonal changes that lead to ureteral dilatation and urinary stasis which in turn contribute to an increased risk of developing urinary tract infection (UTI). This study aimed to determine the frequency of urinary tract infections among pregnant women in Samawa city, Iraq, and examine the isolated organisms. In total, 210 and 55 urine samples were collected from pregnant and non-pregnant women with clinical signs and symptoms of UTI who were hospitalized in the Obstetric and Pediatric Hospital in Samawa, Iraq, respectively. The data collected from each woman included their age, gestational period, parity, level of education, and residence. The frequency of urinary tract infections among the studied woman was 86%. Escherichia coli (38.6%), staphylococcus aureus (20.4%), and Proteus mirabilis (12.7%) were the most frequently isolated bacteria in the current study. According to the recorded data in this study, 86% of the infections in pregnant women occurred in the age group of 25-34 years (52.4%) and the 3rd trimester of pregnancy (49.1%). On the other hand, the results revealed that the infection rate in women with one to three pregnancies was 50.2% more than non-pregnant women. The findings of the current study showed that the highest rate of infection was observed in women who were in the age range of 25-34 years (52.4%). This can be explained by the fact that women often experience the highest reproductive activity during this period. In fact, in this period of life, women are most prone to sexual activity which predisposes them to the introduction of microorganisms to the urinary tract which causes infection. The recorded data showed that UTI became more prevalent with the progress of pregnancy, accounting for 49.1% of infections occurring in the third trimester of pregnancy. Parity and frequent pregnancies are other factors that account for 50.2% of UTI. The prevalence of UTI in women with 1 to 3 children was 58.5%. Moreover, the rate of UTI was 61.3% among pregnant women who attended the antenatal care unit, which was the highest risk of UTI among the pregnant participants. In the non-pregnant women, the prevalence of UTI was 50.2 at the age range of 6-12 years. Based on the obtained results, pregnant women were more vulnerable to renal infection. On the other hand, the concurrence of UTI was positively influenced by sexual activity and pregnancy.

Association of Proteus mirabilis and Providencia stuartii Infections with Diabetes.

Background and Objectives: Proteus and Providencia are related genera of opportunistic pathogens belonging to the Morganellaceae family, often a cause of infections in the immunocompromised hosts, such as diabetic patients. Their clinical significance has increased due to their intrinsic resistance to polymyxins, which is often associated with acquired resistance mechanisms. In this study we evaluated the infections caused by Proteus mirabilis and Providencia stuartii in two groups of patients, with diabetes (group 1) and without diabetes (group 2) admitted to the intensive care unit and surgical wards. The infections were investigated in terms of infection type, risk factors, clinical course, predictive factors for unfavourable outcomes and antibiotic resistance profile. Materials and Methods: An observational, retrospective, cross-sectional study was conducted, comprising all patients infected with these pathogens. Bacterial identification and antibiotic sensitivity testing were performed using the Vitek2C automated system. Results: Comparison of the two groups showed that the statistically significant common infectious risk factors were found less frequently among diabetic patients when compared with non-diabetic patients, and that antimicrobial resistance was significantly lower in the diabetic patient group. However, survival rates did not differ between the two groups, drawing attention to the implications of diabetes as comorbidity. Additionally, with regard to the antibiotic resistance profile, 38.89% of P. stuartii strains isolated from diabetic patients belonged to the difficult-to-treat (DTR) phenotype, contributing to the severity of these infections compared with those caused by P. mirabilis, of which 32% were wild type strains and 0% were DTR phenotype. The DTR/extended spectrum beta-lactamase producing P. stuartii isolates more than doubled the risk of mortality, while the presence of nasogastric nutrition tripled the risk. Conclusions: P. stuartii infections that occurred in diabetic patients proved to be more difficult to treat, the majority of them being healthcare-associated bacteremias.

Otodectic and bacterial etiology of feline otitis externa in Tripoli, Libya.

Background: Feline otitis externa is a dermatological disorder with a multifactorial complex etiology. Aim: This study aimed to investigate the prevalence of different etiological agents, particularly the parasitic and bacterial, responsible for the cases of feline otitis externa in Tripoli, Libya, and to assess the antimicrobial susceptibility of the bacterial isolates from those cases. Methods: Cerumen and otic discharges of the suspected cats were collected for parasite detection and bacterial culture. Kirby-Bauer's disk diffusion method was used for antimicrobial susceptibility testing. Results: The results showed that otodectic mites and bacterial causes were equally the most prevalent in those cases, with a prevalence of 47.1% each. Otodectes cynotis infestation was more frequently bilateral and severe. Staphylococcus spp. were the most prevalent among bacterial causes (75%), followed by Proteus spp. (16.6%) and Pseudomonas spp. (8.4%). Norfloxacin and gentamicin were the most effective antimicrobials against bacterial isolates, as they were effective against 83.3% and 70.8% of isolates, respectively. Conclusion: Otodectes cynotis infestation and staphylococcal infections constituted the most common etiology of feline otitis externa in Tripoli, Libya, and norfloxacin represented a cogent antibacterial for the treatment of otitis externa.

Proteus mirabilis Keratitis: Risk Factors, Clinical Features, Treatment Outcomes, and Microbiological Characteristics.

PURPOSE: To characterize the risk factors, clinical presentations, management choices, and outcomes of Proteus mirabilis keratitis. METHODS: In this retrospective study, 26 culture-proven cases of P. mirabilis infections were diagnosed and treated between 1998 and 2019 at the University of Pittsburgh Medical Center. Medical records were available for 14 keratitis cases and were reviewed for demographic information, ocular risk factors, and treatment outcomes. RESULTS: Sixteen eyes of 14 patients were included in the study. The average age was 47.8 ± 19.3 years, with a median follow-up time of 6 months. The most common ocular risk factors were poor ocular surface and contact lens use in 57.1% and 42.9% of cases, respectively. Eleven of the 14 patients (78.6%) had positive corneal cultures, and 13 of the 14 patients (92.9%) had positive conjunctiva or eyelid cultures. All isolates were susceptible to ciprofloxacin, ofloxacin, moxifloxacin, gatifloxacin, and cefazolin. Surgical intervention was required in 4 patients (28.6%). Average LogMAR visual acuity was 1.3 ± 1.0 at presentation and 0.9 6 ± 1.0 at the most recent follow-up visit. CONCLUSIONS: Proteus mirabilis is an uncommon cause of microbial keratitis. Patients with poor ocular surface and those who use contact lens are at increased risk for developing this cause of keratitis. Empiric treatment with fortified antibiotics or fluoroquinolones seemed to provide effective coverage for P. mirabilis.

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

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.

Clonal outbreak caused by VIM-4-producing Proteus mirabilis in a Greek tertiary-care hospital.

Carbapenem-resistant Enterobacterales have become a major public-health issue worldwide. Here we report an outbreak caused by a clonal multidrug-resistant Proteus mirabilis strain producing VIM-4 metallo-ß-lactamase (MBL) and TEM-2 ß-lactamase in a Greek tertiary-care hospital. From July 2015 to February 2016, 27 imipenem-resistant P. mirabilis isolates were recovered from 14 patients hospitalised in two intensive care units (ICUs) and the internal medicine department in AHEPA University Hospital, Thessaloniki. The isolates were either susceptible or resistant to meropenem and were resistant to all remaining ß-lactams except aztreonam. Phenotypic and molecular analysis revealed that all of the isolates harboured a blaVIM-4 MBL gene. Resistome analysis of a representative isolate showed the presence of an IncQ1 plasmid harbouring the blaVIM-4 carbapenemase and blaTEM-2 ß-lactamase genes among resistance genes coding for resistance to ß-lactams, aminoglycosides, trimethoprim, sulfonamides and lincosamides. Genotyping by pulsed-field electrophoresis (PFGE) revealed that the isolates were epidemiologically related. After recovery of the index carbapenemase-producing P. mirabilis clinical isolate, infection control measures were intensified in the affected departments. Rectal sampling for carbapenem-resistant bacteria was initiated on a weekly basis among patients admitted to the general ICU. The outbreak was finally interrupted 6 months later in February 2016. This is the first documentation of the blaVIM-4 MBL gene in P. mirabilis as well as the first hospital outbreak caused by a MBL-producing P. mirabilis strain.

Prevalence, Etiology, and Outcome of Sepsis among Critically Ill Patients in Malawi.

There are scarce data describing the etiology and clinical sequelae of sepsis in low- and middle-income countries (LMICs). This study describes the prevalence and etiology of sepsis among critically ill patients at a referral hospital in Malawi. We conducted an observational prospective cohort study of adults admitted to the intensive care unit or high-dependency unit (HDU) from January 29, 2018 to March 15, 2018. We stratified the cohort based on the prevalence of sepsis as defined in the following three ways: quick sequential organ failure assessment (qSOFA) score ≥ 2, clinical suspicion of systemic infection, and qSOFA score ≥ 2 plus suspected systemic infection. We measured clinical characteristics and blood and urine cultures for all patients; antimicrobial sensitivities were assessed for positive cultures. During the study period, 103 patients were admitted and 76 patients were analyzed. The cohort comprised 39% male, and the median age was 30 (interquartile range: 23-40) years. Eighteen (24%), 50 (66%), and 12 patients (16%) had sepsis based on the three definitions, respectively. Four blood cultures (5%) were positive, two from patients with sepsis by all three definitions and two from patients with clinically suspected infection only. All blood bacterial isolates were multidrug resistant. Of five patients with urinary tract infection, three had sepsis secondary to multidrug-resistant bacteria. Hospital mortality for patients with sepsis based on the three definitions ranged from 42% to 75% versus 12% to 26% for non-septic patients. In summary, mortality associated with sepsis at this Malawi hospital is high. Bacteremia was infrequently detected, but isolated pathogens were multidrug resistant.

Distribution of extended-spectrum beta-lactamase TEM and CTX-M resistance genes among Proteus species Isolated in Sudan

Proteus species are found in the human intestinal tract as part of normal flora. Proteus species are also found in multiple environmental habitats, including long-term care facilities and hospitals, and can cause both community and nosocomial infections. For a long time Proteus was known to be susceptible to beta-lactam antibiotics but nowadays they become resistant. The aim of this study was to detect the Extended-spectrum beta-lactamase (ESBL) TEM and CTX-M genes in 90 Proteus species isolated from urine and wound swabs, obtained from different hospitals in Khartoum state, Sudan, from January to August 2018. Antimicrobial sensitivity was carried out using the following set of antibiotics: amoxiclav, ceftazidime, gentamicin, meropenem, cefotaxime, ciprofloxacin, amoxicillin, ceftriaxone and cotrimoxazole. ESBL producing strains were detected by double disc diffusion synergy test and the resistance genes TEM and CTX-M were detected by Polymerase Chain Reaction (PCR). Antibiotic resistance was found: amoxicillin 40 percent, ceftazidime 25.6 percent, ceftriaxone 23.3 percent, gentamicin 22.2 percent, cotrimoxazole 21.1 percent, and cefotaxime 18.9 percent. Most of the isolates were sensitive to meropenem 92.2 percent and ciprofloxacin 86.7 percent. In double-disk diffusion synergy test, 20 isolates (22.2 percent) were found to be positive for ESBL. The PCR demonstrated that TEM gene was present in 18 isolates (90 percent). It was present alone in 11 isolates (55 percent) and in combination with CTX-M gene in seven isolates (35 percent). The percentage of ESBL producing strains of Proteus was 23.5 percent. This percentage is a bit lower than in previous studies in Sudan. In conclusion; it seems that the CTX-M gene is emerging among Proteus species in SudanAU)

Las especies de Proteus se encuentran en el tracto intestinal humano y forman parte de su flora normal. También se localizan en el medio ambiente y otros hábitats, incluyendo hospitales y diversas instituciones de salud, provocando tanto infecciones en la comunidad como nosocomiales. Durante mucho tiempo, las especies de Proteus fueron susceptibles a los antibióticos betalactámicos, pero actualmente se han tornado resistentes. El propósito de este estudio fue detectar genes de resistencia betalactamasas de espectro extendido (BLEE) TEM y CTX-M, en 90 especies de Proteus aisladas en orina y heridas, provenientes de diversos hospitales del estado de Jartum, Sudán, entre enero y agosto de 2018. La sensibilidad antimicrobiana se determinó con el siguiente juego de antibióticos: amoxiclav, ceftazidima, gentamicina, meropenem, cefotaxima, ciprofloxacina, amoxicilina, ceftriaxona y cotrimoxasol. Las cepas productoras de BLEE se detectaron mediante la técnica de sinergia de doble disco, y los genes de resistencia TEM y CTX-M mediante Reacción en Cadena de la Polimerasa (PCR). Se encontró resistencia antibiótica: amoxicilina 40 por ciento, ceftazidima 25,6 por ciento, ceftriaxona 23,3 por ciento, gentamicina 22,2 por ciento, cotrimoxasol 21,1 por ciento y cefotaxima 18,9 por ciento. La mayor parte de los aislamientos fueron sensibles a meropenem (92,2 por ciento) y ciprofloxacina (86,7 por ciento). Con la técnica de sinergia de doble disco se detectó positividad a BLEE en 20 aislamientos (22,2 por ciento). Mediante PCR se demostró que el gen que codifica TEM estaba presente en 18 aislamientos (90 por ciento); de forma aislada en 11 aislamientos (55 por ciento) y combinado con el gen CTX-M en los otros siete (35 por ciento). El porcentaje de cepas de Proteus productoras de BLEE fue de 23,5 por ciento. Este valor es ligeramente inferior que los detectados en estudios previos en Sudán. En conclusión, hay evidencias de que el gen CTX-M está emergiendo entre las especies de Proteus en Sudán(AU)

Antimicrobial Susceptibility and Molecular Epidemiology of Proteus mirabilis Isolates from Three Hospitals in Northern Taiwan.

Of all the Proteus spp., Proteus mirabilis is the most common species identified in clinical specimens and is a leading agent of complicated urinary tract infection. This study was undertaken to understand the antimicrobial susceptibility, prevalence of antibiotic resistance genes, and molecular typing of P. mirabilis isolates collected from three hospitals in northern Taiwan. The results showed that the collected isolates of P. mirabilis were susceptible to most antibiotics except cefazolin and tigecycline. Many resistance genes were detected in the collected isolates, of which TEM genes were the most common. Resistance to third- or fourth-generation cephalosporins was related to the presence of at least one of the tested extended-spectrum ß-lactamase (ESBL) or AmpC genes. The presence of the VEB-1 gene seemed to be a good predictor for both cefepime and ceftazidime resistance, which was further supported by quantitative polymerase chain reaction results. Of the four imipenem-resistant P. mirabilis isolates, three isolates could hydrolyze imipenem by mass spectrometry analysis. Molecular typing by pulsed-field gel electrophoresis showed that the pulsotyping of the selected P. mirabilis isolates was heterogeneous. By analyzing the relationship of antimicrobial resistance and the presence of resistance genes, revision of the Clinical and Laboratory Standards Institute cefepime and ceftazidime MIC breakpoints for Enterobacteriaceae to predict ESBL producers might possibly be needed.

Determination of epidemiology and antimicrobial susceptibility of extended spectrum beta lactamase producing uropathogens.

OBJECTIVE: To find the most suitable antibiotic against urinary tract infection caused by Extended Spectrum Beta Lactamase producing uropathogens, and the epidemiology of Extended Spectrum Beta Lactamase producers. METHODS: The cross-sectional study was conducted at Pir Mehr Ali Shah University of Arid Agriculture, Rawalpindi, Pakistan, from July 2014 to July 2015, and comprised urine samples of patients suffering from urinary tract infection which were cultured on Cysteine Lactose Electrolyte Deficient agar medium. Analysis was done on Muller- Hintonagar plates and optical density was set as 0.1 at 530nm. Antimicrobial sensitivity was tested using Kirby-Bauer disc diffusion method. Further confirmation was done through gram staining and biochemical tests. Extended Spectrum Beta Lactamase production was confirmed through phenotypic methods, including phenotypic confirmatory disc diffusion test, double disc synergy test and Epsilometer test. RESULTS: Of the 150 samples, 98(65%) showed growth of a total of 114 pathogenic isolates. Escherichia coli was the commonest organism in 94(82%) samples. Piperacillin Tazocin was the most suitable antimicrobial drug in 88(90%) cases. Overall, 23(20%) isolates were producers of Extended Spectrum Beta Lactamase. CONCLUSION: Piperacillin Tazocin was found to be the drug of choice for patient suffering from urinary tract infection.

Community onset of CTX-M extended spectrum ß-lactamases among uropathogenic E. coli and K. pneumoniae from Karachi, Pakistan.

Urinary tract infections (UTIs) are major health issue in developing countries like Pakistan, become more complicated with extended spectrum ß-lactamase (ESBL) expression in Escherichia coli and Klebsiella pneumoniae. The ground of this present study was to evaluate the incidence of cefotaxime (CTX-M) gene in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. The clinical isolates from various specimens were collected for one-year duration from January till December 2015. After initial screening (n=352) isolates were examined for phenotypic expression of ESBLs by double disc synergy test. Furthermore, eight-four isolates were analyzed by polymerase chain reaction for identification of Cefotaxime (CTX-M), Temoneira (TEM) and Sulfhdryl variable (SHV) genes. Among eighty-four clinical isolates CTX-M was dominant and found positive in 50 isolates (59.5%) followed by TEM in 35 (41.6%) and SHV in 11 (13%). In uropathogenic E. coli and K. pneumoniae, ESBLs gene was found in 50 and 6 isolates out of 57 and 7 respectively. Among uropathogens CTX-M was most prevalent 78% (39/50) in E. coli followed by K. pneumoniae. In uropathogenic E. coli, CTX-M was found dominant in females. The study concluded that ESBL related uropathogenic E. coli were CTX-M dominant, showed community onsets of UTIs that can be preventive and controlled with modified hygienic practices.

Carbapenem-Susceptible OXA-23-Producing Proteus mirabilis in the French Community.

Nineteen Proteus mirabilis isolates producing the carbapenemase OXA-23 were recovered over a 2-year period in 19 French hospitalized patients, of whom 12 had community onset infections. The isolates exhibited a slightly reduced susceptibility to carbapenems. Whole-genome analysis revealed that all 19 isolates formed a cluster compared to 149 other P. mirabilis isolates. Because of its susceptibility to carbapenems, this clone may be misidentified as a penicillinase producer while it constitutes a reservoir of the OXA-23-encoding gene in the community.

Molecular drivers of emerging multidrug resistance in Proteus mirabilis clinical isolates from Algeria.

OBJECTIVES: The aim of this study was to characterise the molecular drivers of multidrug resistance in Proteus mirabilis isolated from Algerian community and hospital patients. METHODS: A total of 166 P. mirabilis isolates were collected from two hospitals and eight private laboratories from four cities (Khemis Miliana, Aïn Defla, Oran and Chlef) located in northwestern Algeria. All isolates were identified by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS). Antimicrobial susceptibility testing was performed by the disk diffusion and Etest methods. Genes encoding AmpC ß-lactamases, extended-spectrum ß-lactamases (ESBLs), quinolone resistance and aminoglycoside-modifying enzymes (AMEs) as well as plasmid replicon typing were characterised by PCR. Clonal relationships were also determined by enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) typing and were compared with MALDI-TOF/MS proteomic typing. RESULTS: Of the 166 P. mirabilis isolates, 14 (8.4%) exhibited resistance to important antibiotics, including amoxicillin, amoxicillin/clavulanic acid, cefotaxime, gentamicin and ciprofloxacin, of which 4/14 (28.6%) had an ESBL genotype (blaCTX-M-2) and 10 (71.4%) had an AmpC/ESBL genotype (blaCMY-2/blaTEM-1). AME genes were detected in all isolates, including ant(2'')-I, aac(3)-I, aac(6')-Ib-cr and aac(3)-IV. The qnrA gene was identified in 13 isolates (7.8%). ERIC-PCR showed one predominant clone, with eight blaCMY-2-producing isolates from UHC Oran belonging to profile A clustering together in the MALDI-TOF/MS dendrogram. CONCLUSION: Here we report the first description of AME and plasmid-mediated quinolone resistance genes among ESBL- and/or AmpC ß-lactamase-producing P. mirabilis isolates from community- and hospital-acquired infections in northwestern Algeria.

Increased Resistance to Carbapenems in Proteus mirabilis Mediated by Amplification of the blaVIM-1-Carrying and IS26-Associated Class 1 Integron.

Objective: The aim of the study was to decipher the mechanisms and associated genetic determinants responsible for increased carbapenem resistance among Proteus mirabilis clinical isolates. Methods: The entire genetic structure surrounding the ß-lactam resistance genes was characterized by PCR, gene walking, and DNA sequencing. Results: A series of clinical P. mirabilis isolates were consecutively recovered from different patients at the Military hospital of Sofia, Bulgaria. They showed variable levels of resistance to carbapenems. All isolates produced the same carbapenemase VIM-1 that was chromosomally encoded. We showed that increased resistance to carbapenems was related to an increased number of blaVIM-1 gene copies. Conclusion: We showed here that increased carbapenem resistance in P. mirabilis may result from increased expression of the blaVIM-1 carbapenemase gene through multiplication of its copy number.

Primary and Secondary Bacteremia Caused by Proteus spp.: Epidemiology, Strains Susceptibility and Biofilm Formation.

Proteus spp. is an etiological factor of urinary tract and bloodstream infections. The aim of this study was the retrospective analysis of susceptibility of Proteus spp. strains isolated from bloodstream infections (BSIs) as well as similarity evaluation of the strains isolated from different clinical samples. Proteus spp. strains were isolated in 2009-2017 from hospital patients. Identification was based on the colony's morphology and biochemical or MALDI-TOF MS analyzes. The antibiotic susceptibility test was done using the diffusion method. Biofilm formation was evaluated with microplate method using TTC. Bacteremia caused by Proteus spp. was found in 97 patients, mainly secondary to urinary tract infection. Most of the strains were susceptible to piperacillin with tazobactam (95.9%) and amikacin (86.7%). Elderly patients have a higher risk of mortality after BSIs caused by Proteus spp. A detailed analysis was made for randomly chosen 26 strains isolated from 11 patients with Proteus mirabilis bacteremia. Using PFGE, we found that 10 (90.9%) isolates, collected from different clinical specimens of the same patient, were genetically identical.Proteus spp. is an etiological factor of urinary tract and bloodstream infections. The aim of this study was the retrospective analysis of susceptibility of Proteus spp. strains isolated from bloodstream infections (BSIs) as well as similarity evaluation of the strains isolated from different clinical samples. Proteus spp. strains were isolated in 2009­2017 from hospital patients. Identification was based on the colony's morphology and biochemical or MALDI-TOF MS analyzes. The antibiotic susceptibility test was done using the diffusion method. Biofilm formation was evaluated with microplate method using TTC. Bacteremia caused by Proteus spp. was found in 97 patients, mainly secondary to urinary tract infection. Most of the strains were susceptible to piperacillin with tazobactam (95.9%) and amikacin (86.7%). Elderly patients have a higher risk of mortality after BSIs caused by Proteus spp. A detailed analysis was made for randomly chosen 26 strains isolated from 11 patients with Proteus mirabilis bacteremia. Using PFGE, we found that 10 (90.9%) isolates, collected from different clinical specimens of the same patient, were genetically identical.

Occurrence of Salmonella genomic island 1 (SGI1) in two African Proteus mirabilis strains isolated from diseased chicken flocks.

Two P. mirabilis strains, PmSHR21 and PmSHR38, were collected from chicken flocks in Sharkia Governorate, Egypt in 2016. The two strains showed multidrug-resistance (MDR) phenotypes and were detected to harbour I) floR and sul1 genes conferring resistance to florfenicol and chloramphenicol, and sulfonamides, respectively, II) a ~1.9 kbp class 1 integron containing aadA2-lnuF genes conferring resistance to spectinomycin and streptomycin, and lincosamides, respectively. Interestingly, the two strains were detected to contain SGI1 variant, SGI1-W and inserted between the 3' end of the chromosomal trmE gene and the hipB/hipA toxin/antitoxin homologue. Fingerprinting by ERIC-PCR of the two poultry strains identified in this study and the two human SGI1-carrying P. mirabilis strains described recently in our study showed identical ERIC-pattern between SGI1-W-carrying poultry and human strains, suggesting that they might be clonally related. The detection of SGI1 and its variants in P. mirabilis isolated from humans and chicken flocks in Egypt clarify the geographical and biological spreading through an inter-transmission pathway. To the best of our knowledge, this is the first study detecting SGI1-positive P. mirabilis isolated from chicken flocks in Africa.

Occurrence of TEM, SHV and CTX-M ß Lactamases in Clinical Isolates of Proteus Species in a Tertiary Care Center.

BACKGROUND: Extended spectrum beta lactamases (ESBL) are responsible for increased resistance to third generation cephalosporins. Proteus species is an important cause of both community acquired and nosocomial infections. The Proteus species is usually susceptible to beta lactam drugs but there is progressive increase in beta lactam resistance and recently, ESBLs are also fast spreading to this species. OBJECTIVE: This study was conducted to study ESBL production and occurrence of TEM, SHV and CTX-M beta lactamases in clinical isolates of Proteus species in a tertiary care center. METHOD: This prospective hospital based study was carried out in Microbiology, Kasturba Medical College, Mangalore over 9 months. All non-duplicate consecutive Proteus isolates were identified and antibiotic susceptibility testing was done. ESBL detection was done by double disk synergy method and TEM, SHV, CTX-M genes were detected by PCR. RESULTS: 84 Proteus isolates from urine (29), blood (1), respiratory secretions (2), tissue (20) and exudates (47) were included in the study. 20.2% (17) were ESBL positive by disk synergy method. CTX-M was present in 6, TEM in 2 and both in 9 isolates. SHV was not present in any isolate. CONCLUSION: Our findings showed that 20% of clinical isolates of Proteus species were ESBL producers. 52% of ESBL positive isolates carried both TEM and CTX-M genes followed by CTX-M alone (35%) and only 11% had TEM alone. This stresses on the fact that ESBL detection should be done routinely in Proteus isolates and the genotype surveyed periodically for better management.

Dissemination of Multidrug-Resistant Proteus mirabilis Clones Carrying a Novel Integron-Borne blaIMP-1 in a Tertiary Hospital.

This study aimed to characterize multidrug-resistant Proteus mirabilis clones carrying a novel class 1 integron-borne blaIMP-1 In1359 was inserted into a large conjugative plasmid that also carried blaCTX-M-2 The production of carbapenemases in Enterobacteriaceae that are intrinsically resistant to polymyxins and tigecycline is very worrisome, representing a serious challenge to clinicians and infection control teams.

Propensity-matched analysis of the impact of extended-spectrum ß-lactamase production on adults with community-onset Escherichia coli, Klebsiella species, and Proteus mirabilis bacteremia.

BACKGROUND: The presence of extended-spectrum ß-lactamase (ESBL) in Escherichia coli, Klebsiella species, and Proteus mirabilis (EKP) is of great microbiological and clinical importance. The study dealing with the direct impact of ESBL producers on the outcome of patients with community-onset bacteremia is lacking. METHODS: Adults with community-onset EKP bacteremia were recruited retrospectively during a 6-year period. ESBL producers were determined according to ESBL phenotype. ESBL patients were compared on a 1:2 basis with non-ESBL patients by using propensity-score matching (PSM) calculated based on independent predictors of 28-day mortality. RESULTS: Of the 1141 eligible adult patients, 65 (5.7%) caused by ESBL producers. Significant differences between the two groups were discovered in the proportions of patients with critical illness (a Pitt bacteremia score ≥ 4) at bacteremia onset, inappropriate empirical antibiotic therapy, bacteremia because of urosepsis and pneumonia, and several comorbidities. In a PSM analysis after controlling for six independent predictors-critical illness at bacteremia onset, underlying fatal comorbidities (McCabe classification), inappropriate empirical antibiotic therapy, comorbidities with liver cirrhosis, bacteremia because of urosepsis and pneumonia-a appropriate matching between two groups (ESBL group, 60 patients; non-ESBL group, 120) were observed in age, causative microorganism, bacteremia severity, major comorbidities, comorbidity severity, and major bacteremia source. Consequently, a strong relationship between ESBL producers and poor prognosis was highlighted. CONCLUSIONS: The adverse influence of ESBL producers on clinical outcomes was presented with respect to adults with community-onset EKP bacteremia. Establishing a predictive scoring algorithm for identifying patients at risk of ESBL-producer infections is crucial.