OCCURRENCE AND IDENTIFICATION OF FLUOROQUINOLONE RESISTANCE IN PROTEUS MIRABILIS CLINICAL ISOLATES FROM INTENSIVE CARE UNIT PATIENTS WITH URINARY TRACT INFECTIONS
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Keywords
Proteus mirabilis, Urinary Tract Infections (UTIs), Gram-Negatives Organisms, Gram-Positive Organisms, Genes
Abstract
Proteus mirabilis is a small gram-negative bacillus commensal of GIT and mainly causes urinary tract infections (UTIs). Fluoroquinolones are synthetic antimicrobial agents and are one of the most prescribed antibiotics. In this study, Proteus mirabilis isolates were obtained from urine cultures of ICU patients. Briefly, urine samples (n=100) were inoculated on CLED, MacConkey, and Blood agar. The isolates were primarily identified by using conventional microbiological tools and biochemical testing and confirmed based on ureC gene amplification using PCR. The confirmed isolates were initially screened for fluoroquinolone resistance using the Kirby-Bauer disk diffusion method. The MICs were estimated using E-Test strips. Lastly, PCR was done to screen isolates for PMQR (plasmid-mediated quinolone resistance) genes, namely qnrA, qnrB, and qnrS. A total of nine samples (9%) yielded Proteus mirabilis, while all other culture-positive plates were either non-Proteus Gram-negatives and some samples had gram-positive organisms. All the isolates were Gram-negative rods, motile, and non-spore former. All isolates were Indole, oxidase, and VP negative, while positive for urease, catalase, H2S, and Methyl red. Further API 20E test strips also confirmed the isolates as P. mirabilis. PCR testing yielded 533bp bands of the ureC gene in all nine isolates, which confirmed them as P. mirabilis. Antibiogram analysis revealed diverse resistance patterns but all the isolates were found to be quinolone-resistant both in disk diffusion as well as in E test results with the highest MIC of ≤64 µg/ml. The qnrA band size was recorded ≈516 bp, while the qnrS band size was recorded ≈417 bp. All the isolates were screened for qnrA, qnrB, and qnrS genes. The overall frequency of qnrA was (4/9)44.44%, qnrB (0/9)0.00%, qnrS (6/9)66.66%, respectively.
References
2. Borghi, L., Nouvenne, A., & Meschi, T. (2012). Nephrolithiasis and urinary tract infections:‘the chicken or the egg’dilemma? Nephrology Dialysis Transplantation, 27(11), 3982-3984.
3. Brusselaers, N., Vogelaers, D., & Blot, S. (2011). The rising problem of antimicrobial resistance in the intensive care unit. Annals of intensive care, 1, 1-7.
4. Carson, C., & Naber, K. G. (2004). Role of fluoroquinolones in the treatment of serious bacterial urinary tract infections. Drugs, 64, 1359-1373.
5. De Champs, C., Bonnet, R., Sirot, D., Chanal, C., & Sirot, J. (2000). Clinical relevance of Proteus mirabilis in hospital patients: a two year survey. Journal of Antimicrobial Chemotherapy, 45(4), 537-539.
6. Debiaggi, M., Canducci, F., Brerra, R., Sampaolo, M., Marinozzi, M. C., Parea, M., Arghittu, M., Alessandrino, E. P., Nava, S., & Nucleo, E. (2010). Molecular epidemiology of KI and WU polyomaviruses in infants with acute respiratory disease and in adult hematopoietic stem cell transplant recipients. Journal of medical virology, 82(1), 153-156.
7. Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews microbiology, 13(5), 269-284.
8. Geetha, D., Poulton, C. J., Hu, Y., Seo, P., McGregor, J. A. G., Falk, R. J., & Hogan, S. L. (2014). Clinical characteristics and outcome of pauci-immune glomerulonephritis in African Americans. Seminars in arthritis and rheumatism,
9. Gopalan, N., Chandrasekaran, P., Swaminathan, S., & Tripathy, S. (2016). Current trends and intricacies in the management of HIV-associated pulmonary tuberculosis. AIDS research and therapy, 13, 1-19.
10. Jacobsen, S. M., & Shirtliff, M. E. (2011). Proteus mirabilis biofilms and catheter-associated urinary tract infections. Virulence, 2(5), 460-465.
11. Jombo, G., Emanghe, U., Amefule, E., & Damen, J. (2012). Nosocomial and community acquired uropathogenic isolates of Proteus mirabilis and antimicrobial susceptibility profiles at a university hospital in Sub–Saharan Africa. Asian Pacific Journal of Tropical Disease, 2(1), 7-11.
12. Noppon, B., Sampao, S. W., Sornplang, P., Sopa, A., Sukon, P., & Kanistanon, K. (2018). Multi-drug resistance characteristics of e. coli isolated from water sources in chicken farms, Khon Kaen, Thailand. Southeast Asian Journal of Tropical Medicine and Public Health, 49(6), 1034-1042.
13. Paterson, D. L., & Bonomo, R. A. (2005). Extended-spectrum β-lactamases: a clinical update. Clinical microbiology reviews, 18(4), 657-686.
14. Rao, R. S., Karthika, R. U., Singh, S., Shashikala, P., Kanungo, R., Jayachandran, S., & Prashanth, K. (2008). Correlation between biofilm production and multiple drug resistance in imipenem resistant clinical isolates of Acinetobacter baumannii. Indian journal of medical microbiology, 26(4), 333.
15. Rosenberg, A. L., & Watts, C. (2000). Patients readmitted to ICUs: a systematic review of risk factors and outcomes. Chest, 118(2), 492-502.
16. Setsukinai, K.-i., Urano, Y., Kakinuma, K., Majima, H. J., & Nagano, T. (2003). Development of novel fluorescence probes that can reliably detect reactive oxygen species and distinguish specific species. Journal of Biological Chemistry, 278(5), 3170-3175.
17. Subramanian, P., Shanmugam, N., Sivaraman, U., Kumar, S., & Selvaraj, S. (2012). Antiobiotic resistance pattern of biofilm-forming uropathogens isolated from catheterised patients in Pondicherry, India. The Australasian medical journal, 5(7), 344.
18. Takeda, M., Sakaki, N., Honda, K., Chikawa, M., Fukushima, M., Hayashida, N., Inoue, N., Kadota, K., Kakimoto, F., & Kamata, K. (2003). Energy determination in the akeno giant air shower array experiment. Astroparticle Physics, 19(4), 447-462.
19. Van Doorslaer, X., Dewulf, J., Van Langenhove, H., & Demeestere, K. (2014). Fluoroquinolone antibiotics: an emerging class of environmental micropollutants. Science of the Total Environment, 500, 250-269.
20. Yousefi, M., Pourmand, M. R., Fallah, F., Hashemi, A., Mashhadi, R., & Nazari-Alam, A. (2016). Characterization of Staphylococcus aureus biofilm formation in urinary tract infection. Iranian journal of public health, 45(4), 485.
21. Yuan, Y., & Gao, M. (2017). Jumbo bacteriophages: an overview. Frontiers in microbiology, 8, 403.
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Faiza Riaz
Department of Microbiology, Government College University Faisalabad, Pakistan.
Fayez Ali Siddiqui
Department of Biotechnology, University of Karachi, Pakistan
Dr Muhammad Abbas
Sarhad Institute of Health Sciences, Sarhad University of Science & Information Technology Peshawar, Pakistan
Dr Qandeel Abbas Soomro
Department of Pathology, Indus Medical College Tando Muhammad Khan, Pakistan
Qurratulaen Raza
Margalla College of Pharmacy, Margalla Institute of Health Sciences, Pakistan
Faziyya Latif
Iqra University, H-9 Islamabad Campus, Pakistan
Zeeshan Ahmad
Department of Eastern Medicine and Surgery, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Pakistan
Abdul Wahab
Department of Microbiology, Government College University Faisalabad, Pakistan.