Multidrug-Resistant Proteus mirabilis Infections and Clinical Outcome at Tertiary Hospital in Riyadh, Saudi Arabia

Background

Proteus mirabilis (P. mirabilis) is known to cause various infections, most commonly urinary tract infections, and is a threat to hospitalized patients, especially in long-stay departments that utilize invasive devices. This study aims to fill the knowledge gap regarding P. mirabilis epidemiology and antimicrobial resistance in Saudi Arabia. It investigates epidemiological patterns, resistance characteristics, and clinical outcomes among P. mirabilis patients at King Fahad Medical City in Riyadh from 2019 to 2021.

Methods

A total of 598 P. mirabilis isolated from diverse clinical specimens, including the clinical information of 78 intensive care unit (ICU) patients, were included in the current study. The Phoenix BD instrument was used for complete identification and sensitivity testing of Proteus spp. Demographic, clinical, and outcome data were reported and compared using statistical analysis.

Results

Pan-drug-resistant isolates were identified in 2019 (n = 6), although multi- and extensively drug-resistant isolate frequencies were greatest among all patients in 2019. The highest susceptibility levels were observed for piperacillin-tazobactam, carbapenems, and cephalosporins antibiotics. In contrast, Cephalothin, trimethoprim-sulfamethoxazole, and ampicillin had the lowest susceptibilities. Urine infections with a positive culture of P. mirabilis were significantly higher in females and non-ICU patients (p <0.001), but respiratory infections were significantly higher in ICU patients (p <0.001). Moreover, ICU patients infected with P. mirabilis and undergoing renal dialysis have a 7.2-fold (P 0.034) higher risk of death than those not receiving dialysis.

Conclusion

Hospitalized patients are at risk of fatal consequences due to P. mirabilis infection. It is crucial to conduct further investigation to fully understand the severity of this issue and take necessary measures to prevent it.

Prevalence of Indigenous Antibiotic-Resistant Salmonella Isolates and Their Application to Explore a Lytic Phage vB_SalS_KFSSM with an Intra-Broad Specificity

The consumption of fresh produce has led to increase in antibiotic-resistant (AR) Salmonella outbreaks. In this study, indigenous Salmonella was isolated from a total of two hundred-two samples including fresh produce and agricultural environmental samples in Korea. After biochemical confirmation using the Indole, Methyl Red, Voges-Proskauer, Citrate tests, presumable Salmonella isolates were identified by 16S rRNA sequencing. Identified Salmonella isolates were evaluated for antibiotic susceptibility against twenty-two antibiotics. The specificity and the efficiency of plating (EOP) of vB_SalS_KFSSM were evaluated against fifty-three bacterial strains. Twenty-five suspected Salmonella were isolated and confirmed by the positive result for methyl red and citrate, of which ten were identified as Salmonella spp. through 16S rRNA gene sequencing. Eight Salmonella isolates (4.0%, n = 8/202) were resistant to at least one antibiotic, among which five were multi-drug resistant. As a lytic phage against Salmonella spp. CMGS-1, vB_SalS_KFSSM was isolated from cow manure. The phage was observed as a tailed phage belonging to the class Caudoviricetes. It exhibited an intra-broad specificity against four indigenous AR Salmonella isolates, two indigenous Salmonella isolates, and five other Salmonella serotypes with great efficiencies (EOP ≥ 0.75). Thus, this study suggested the potential of vB_SalS_KFSSM to combat indigenous AR Salmonella.

Pericarditis caused by Proteus mirabilis in sheep

Pericarditis means inflammation in the pericardial sac. Pericarditis is divided into three categories based on morphology, including fibrinous, purulent, and constrictive. In the present study, a 7-month-old male Ghezel breed sheep was examined for low weighting rate for three months. Tachypnea, tachycardia, heart friction sound, absence of fever and normal appetite were recorded in the clinical examination. In the patient's history, there was a history of perforated chest trauma behind the left scapula about three months ago. After the echocardiography examination and bacteriology procedures, purulent pericarditis caused by Proteus mirabilis was diagnosed. The bacterium was analysed using genome sequencing and new strain called Abhar114 was diagnosed. This is the first report of pericarditis caused by Proteus mirabilis in sheep.

Prevalence and Antibiotic Susceptibility of Proteus mirabilis Isolated from Clinical Specimens in the Zainoel Abidin General Hospital, Banda Aceh, Indonesia

BACKGROUND: Proteus mirabilis is Gram-negative bacteria from the Enterobacteriaceae family causing various infections. AIM: This study aimed to determine the prevalence and distribution of Proteus mirabilis isolated from clinical specimens based on patients’ age, gender, type of specimen, and patient wards and their antibiotic sensitivity. METHODS: This study involved isolating, identifying, and testing antibiotic susceptibility to Proteus mirabilis isolates recoverred from clinical specimens of dr. Zainoel Abidin general hospital Banda Aceh during March 2020-March 2022. RESULTS: This study showed that 121 isolates of Proteus mirabilis were obtained from clinical specimens during the study with prevalence of almost 2%. Proteus mirabilis distribution based on the specimen type was most predominantly found in pus specimens and from patients in the the operating room and post surgery ward accounting for 84.29% and 35.53%. Proteus mirabilis was detected most frequently in individuals aged 46-55 years old (30.57 %), whereas it was found more frequently in men (71%) based on gender. The susceptibility of Proteus mirabilis to antibiotics was highest to cefoperazone, piperacillin/tazobactam, and amikacin reaching reaching 97.5%, 97.5, and 96.66%, respectively. CONCLUSION: The distribution of Proteus mirabilis isolates predominantly in pus specimens indicating its association with wound infections. Despite some antibiotics remain effective, implementation of the regular surveillance programs along with rational use of antibiotics may prevent the bacterial pathogen to spread particularly within healthcare settings.