Characterization of antibiotic resistance in Proteus species isolated from urinary tract infections in a tertiary care hospital

Background: The rapid emergence of carbapenemase producing healthcare-associated Proteus spp. causing Urinary tract infections (UTI) is a matter of great concern. The current study was carried out to determine the prevalence of Extended Spectrum Beta Lactamases (ESBLs), plasmidic Ampicillinases (pAmpC) and carbapenemases in multi-drug resistant (MDR) Proteus isolates, collected from UTI specimens in Hayatabad Medical Complex Peshawar, Pakistan. Methods and materials: A total of 150 isolates from UTI patients were collected, which were further re-confirmed by standard microbiological procedures. Antibiotic susceptibility was done by Kirby-Bauer disk diffusion method. Phenotypic detection of ESBLs, MBLs and pAmpC was conducted by combined disk diffusion and Double Disk Synergy Test (DDST) method. Conventional PCR was done for ureC and NDM-1, while multiplex-PCR was performed for detection of ESBLs, MBLs, and pAmpC genes. Results: Out of 150 isolates, 50 were confirmed as Proteus spp (Proteus mirabilis (46) and Proteus vulgaris (4)). All isolates displayed β-lactam resistance. Highest resistance was examined against erythromycin (80%) and rifampicin (72%), while resistance towards levofloxacin and imipenem was noticed as 60% and 58% respectively. Positive PCR detection of ESBLs, MBLs, pAmpC and NDM-1 were 48%, 28%, 36%, and 56% respectively. Conclusion: To the best of our knowledge, this was the first report of the β-lactamases prevalence in Proteus spp. from Pakistan. The emergence of MDR Proteus strains carrying ESBLs, MBLs, pAmpC and NDM-1 in hospital patients presented a major health problem, as these strains displayed resistance against commonly used antibiotics. Concerted efforts were needed to contain these MDR pathogens, with careful prescription of antibiotics and effective cleanliness procedures in hospital setting.

Abstract licence: CC BY-NC-ND

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