Abstract
Proteus mirabilis is the third most common etiological factor of urinary tract infection. It produces urease, which contributes to the formation of a crystalline biofilm, considered to be one of the most important virulence factors of P. mirabilis strains, along with their ability to swarm on a solid surface. The aim of this study was to analyze the pathogenic properties of two selected groups of clinical P. mirabilis isolates, antimicrobial susceptible and multidrug resistant (MDR), collected from hospitals in different regions in Poland. The strains were examined based on virulence gene profiles, urease and hemolysin production, biofilm formation, and swarming properties. Additionally, the strains were characterized based on the Dienes test and antibiotic susceptibility patterns. It turned out that the MDR strains exhibited kinship more often than the susceptible ones. The strains which were able to form a stronger biofilm had broader antimicrobial resistance profiles. It was also found that the strongest swarming motility correlated with susceptibility to most antibiotics. The correlations described in this work encourage further investigation of the mechanisms of pathogenicity of P. mirabilis.
Highlights
Following Escherichia coli and Klebsiella pneumoniae, Proteus mirabilis is the third most common etiological factor of urinary tract infection (UTI) (Rózalski et al, 2012; Cestari et al, 2013; Kwiecinska-Pirog et al, 2016; Peng et al, 2016; Armbruster et al, 2018), being mainly responsible for complicated UTIs or UTIs in long-term catheterized patients
Previous reports have documented a remarkable epidemiological success of the multidrug resistant (MDR) AmpCproducing strains in Greece, Italy, and Poland, where they accounted for approximately 20% of nosocomial clinical P. mirabilis isolates (Literacka et al, 2004; D’Andrea et al, 2011)
Owing to specific virulence factors, P. mirabilis is troublesome for catheterized patients and is responsible for complicated UTI with the development of urinary stones (Jacobsen and Shirtliff, 2011; Niveditha et al, 2012; FloresMireles et al, 2015)
Summary
Following Escherichia coli and Klebsiella pneumoniae, Proteus mirabilis is the third most common etiological factor of urinary tract infection (UTI) (Rózalski et al, 2012; Cestari et al, 2013; Kwiecinska-Pirog et al, 2016; Peng et al, 2016; Armbruster et al, 2018), being mainly responsible for complicated UTIs or UTIs in long-term catheterized patients. The ability of P. mirabilis to form apatite or/and struvite stones in the bladder and the kidney causes severe pain in patients and augments therapeutic difficulties (Wei et al, 2014; Kwiecinska-Pirog et al, 2016; Norsworthy and Pearson, 2017). P. mirabilis expresses several virulence factors that allow for, e.g., effective motility against the stream of urine, uptake of nutrients, or protection from the host defense system. P. mirabilis carries genes of 17 distinct fimbrial structures, the most important
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