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Introduction    Proteus mirabilis  is a biofilm-forming agent that quickly settles on the urinary catheters and causing catheter-associated urinary tract infections. Thus, the spread of multidrug-resistant  P. mirabilis  isolates, with the ability to form a biofilm that carries integron, extended-spectrum  β -lactamases (ESBLs), and plasmid-mediated colistin resistance genes ( mcr ), represents a severe threat to managing nosocomial infectious diseases. This study is aimed at surveying the prevalence of ESBL, integrase, and  mcr  genes of  P. mirabilis , isolated from the catheter, to assess the differences in their antimicrobial susceptibility and clonal dissemination.Method   Microtiter plate assay was adopted to measure biofilm formation. The antimicrobial susceptibility was assessed by the disk diffusion method. Antimicrobial resistance genes ( intI1 ,  intI2 ,  intI3 ,  bla  TEM ,  bla  CTX-M ,  bla  SHV ,  mcr1 , and  mcr2 ) were detected by PCR. All of the isolates were characterized by repetitive sequence-based PCR.Result   From 385 collected catheters in patients admitted to the intensive care unit (ICU), 40  P. mirabilis  were isolated. All of the isolates could form a biofilm.  Proteus  spp. had intrinsic resistance to tetracycline (95%) and nitrofurantoin (92.5%), which explains the high resistance prevalence. The most widely resistant antibiotic was trimethoprim-sulfamethoxazole (75%). Thirty-three (82.5%) isolates were classified as multidrug resistance (MDR). The prevalence of  intI1  and  intI2  genes was 60% and 25%, respectively. In 6 (15%) isolates, both genes were detected. The most frequent ESBL gene detected in all of the isolates was  bla TEM  . Also, no detection for  mcr1  and  mcr2  antibiotic resistance genes was reported. Rep-PCR identified 39(GTG)5 types (G1–G39) of 40 isolates that 38 isolates had unique patterns.Conclusion   In this study, 82.5% of isolates were MDR with high antibiotic resistance to trimethoprim-sulfamethoxazole. The  intI1  and  bla  TEM  were the most prevalent genes in the integrase and ESBL gene family. High diversity was seen in the isolates with Rep-PCR. The increasing rate of MDR isolates with a high prevalence of resistance genes could be alarming and demonstrate the need for hygienic procedures to prevent the increased antibiotic resistance rate in the future.

biomed research international

From the Urinary Catheter to the Prevalence of Three Classes of Integrons, β-Lactamase Genes, and Differences in Antimicrobial Susceptibility of Proteus mirabilis and Clonal Relatedness with Rep-PCR