الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 152 |  |  |
| | | from | 152 | | |
Abstract
Proteus species is intimately linked to complicated UTIs, particularly in individuals with functional or anatomical problems, like urinary stones and long-term catheters.
Misuse of antibiotics has increased bacterial pathogenicity and resulted in an increase in antibiotic resistance. The growing number of Proteus strains that produce ESBLs represents an alarming risk. ESBLs are one of the major resistance mechanisms among Proteus bacteria that have been associated with resistance to different classes of antibiotics in addition to β-lactam antibiotics.
This study aimed to detect the frequency of Proteus species in UTI and the rate of resistance of these strains to different antibiotics. Also, this study tests the ability of Proteus strains to produce ESBL enzymes by phenotypic and genotypic methods. The genetic similarity between ESBL producing Proteus isolates was also examined.
The study tested 51 Proteus strains isolated from 300 urine samples from inpatients and outpatients with UTIs who attended Minia university hospitals. Identification of Proteus isolates was performed by colony morphology, gram staining, and standard biochemical tests. All isolates were analyzed for P. mirabilis identification by PCR using 16srRNA gene. Antibiotic susceptibility testing for all Proteus isolates was performed using disc diffusion method. Broth microdilution method was used for SXT resistance detection. For identification of ESBL producing Proteus strains, double disk synergy test was done to isolates that showed resistance to third generation cephalosporin antibiotics.
SXT resistance genes (sul I and sul II) were analyzed by uniplex PCR. ESBL enzymes genes (bla TMP , bla SHV) were tested using uniplex PCR and (bla CTX-M 1,2,8,9,25 genes) by multiplex PCR.
Typing of ESBL producing Proteus strains were analyzed using ERIC-
PCR.
Out of 253 samples of bacteriurea, 51 Proteus isolates were identified. 96.1% of isolates were identified as P. mirabilis. It was detected that Proteus strains had high antimicrobial resistance. The most resistant antibiotics against Proteus were cefazolin (100% resistance), SXT (80.4% resistance) and AMC (56.9% resistance). The most effective antibiotic was gentamycin (7.8% resistance) followed by amikacin (13.7% resistance). Forty two (82.4%) of the isolates were classified as MDR isolates.
The percentage of SXT resistance was 80.4% by disc diffusion method and 70.6% by broth microdilution method.
Among Proteus isolates, the distribution of sul genes was very high. sul I gene was detected in 12.2% of isolates, sul II gene was found in 17.1% of isolates while 63.4% of isolates had both sul I and sul II genes.
Out of 51 Proteus isolates, 19 isolates (37.3%) were ESBL producing strains, which were more frequently found in catheterized inpatients. Also, the susceptibility pattern of ESBL-producing isolates demonstrated that these isolates were more resistant to other types of antibiotics rather than non-ESBL strains.
The frequency of ESBL genes among Proteus isolates were as the following: 26.3% of isolates had bla TEM gene, 15.8% of isolates had bla CTX-M 9 while only 5.3% of isolates had bla SHV gene. Bla CTX 1, 2, 8, and 25 were not detected in any isolate.
Typing by ERIC-PCR technique to ESBL producing Proteus isolates revealed that the isolates did not show high degree of similarity.