Prevalence, Antibiotic Susceptibility Pattern and Detection of Transferable Resistant Genes in Proteus Species from Urinary Tract Infections in a Tertiary Hospital in South-East of Nigeria

Abstract

Drug-resistant Proteus species cause global public health threats, including in Nigeria, due to antibiotic resistance. Objective: To determine the prevalence, antibiotic susceptibility, and detection of resistant genes in Proteus species causing UTIs in a Nigerian hospital. Methods: A cross-sectional study was conducted over seven months at Alex-Ekwueme Federal University Teaching Hospital in Abakaliki, Ebonyi State, Nigeria. The study included 650 urine samples from male and female in-patients and out-patients displaying UTI symptoms. Disc diffusion method was used for antimicrobial susceptibility testing and double disc-synergy test was employed to check for the presence of extended spectrum beta-lactamases. Polymerase chain reaction (PCR) was utilized to screen for transferable resistant genes and mobile genetic elements. Results: Out of 650 urine samples, 84 (12.9%) Proteus species isolates were identified. 60 (71.4%) were Proteus mirabilis and 24 (28.6%) were Proteus vulgaris. Females had a higher distribution of isolates (76.2%) compared to males (23.8%) (p=0.010). Age group showed higher isolates in the 31-40 (23.8%) and 41-50 (22.6%) age groups (p<0.001). No significant association was found between Proteus species and urine types or patient categories (p=0.061 and p=1.000, respectively). Levofloxacin and ceftazidime exhibited the greatest effectiveness, while nalidixic acid, imipenem, and nitrofurantoin displayed the highest resistance against Proteus species. 56% of Proteus isolates were multidrug resistant. PCR analysis detected TEM (23.1%), CTX-M (23.1%), SHV (15.4%), aab(61)-1b (10.3%), qnrB (2.6%), and class 1 integrase gene (25.7%). Conclusions: Proteus isolates carry transferable resistant genes associated with class 1 integrase.