Determinants of virulence and antimicrobial resistance in Proteus species from women with urinary tract infections in Lafia, Nigeria

Abstract

Urinary tract infections (UTI) are a recurring issue in women’s health as a result of the associated high economic burden. Our study profiled antibiotic resistance and virulence factors in Proteus species isolated from women with UTI from the University Teaching Hospital, Lafia, Nigeria. A total of 368 women aged 18 and above participated in the study. Urine samples were collected from volunteers and screened for significant bacteriuria using the pour plate technique. The isolates were identified using biochemical tests, and Proteus species were characterized for antibiotic susceptibility using the Kirby–Bauer disk diffusion method. The plasmids of the isolates were extracted and identified using agarose gel electrophoresis. Only 21 participants had significant bacteriuria, and 9 bacterial genera were isolated from their urine samples. Escherichia coli (52.4%), Klebsiella sp. (57.1%), and Proteus sp. (42.9%) were the most occurring species, while Corynebacterium sp. (4.8%) was found in only one patient. The demographic profile revealed that women aged 31–40 with a 40% incidence of Proteus sp. were the most susceptible group, and women who use a water system for sewage disposal and a borehole water source each had an incidence of 80%, respectively. Four Proteus isolates, P3, P5, P6, and P9, were resistant to nine antibiotics, and streptomycin had the best inhibition against the 10 Proteus isolates. Adhesion and hemolysin plasmids were the most commonly identified virulence plasmids, while resistance plasmids included conjugative R-plasmid, extended-spectrum beta-lactamase plasmids, and multi-conjugative plasmids of 50 kb, 40 kb, 80 kb, and 200 kb, respectively. The findings underscore the need for improved surveillance of antibiotic resistance promoters in the community. The co-occurrence of multiple plasmids is of concern as it promotes antibiotic resistance through horizontal gene transfer.

Keywords

Antibiotic resistance / Virulence / Plasmids / Demographic profile / Bacteriuria

References

[1] Mancuso G, Midiri A, Gerace E, Marra M, Zummo S, Biondo C. Urinary tract infections: The current scenario and future prospects. Pathogens . 2023; 12(4): 623. doi: 10.3390/pathogens12040623

[2] Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015; 13(5): 269-284. doi: 10.1038/nrmicro3432

[3] Schaffer JN, Pearson MM. Proteus mirabilis and urinary tract infections. Microbiol Spectr . 2015; 3(5): UTI-0017-2013. doi: 10.1128/microbiolspec.UTI-0017-2013

[4] Drzewiecka D. Significance and roles of Proteus spp. bacteria in natural environments. Microb Ecol . 2016; 72(4): 741-758. doi: 10.1007/s00248-015-0720-6

[5] Chakkour M, Hammoud Z, Farhat S, El Roz A, Ezzeddine Z, Ghssein G. Overview of Proteus mirabilis pathogenicity and virulence: Insights into the role of metals. Front Microbiol. 2024; 15: 1383618. doi: 10.3389/fmicb.2024.1383618

[6] Soliman S, Abdalla S, Zedan A, et al. Genomic profiling of pan-drug resistant Proteus mirabilis isolates reveals antimicrobial resistance and virulence gene landscape. Funct Integr Genomics. 2024; 24(5): 154. doi: 10.1007/s10142-024-01419-7

[7] Bedenić B, Pospišil M, Nađ M, Bandić Pavlović D. Evolution of β-lactam antibiotic resistance in Proteus species: From extended-spectrum and plasmid-mediated AmpC β-lactamases to carbapenemases. Microorganisms . 2025; 13(3): 508. doi: 10.3390/microorganisms13030508

[8] Yang J, Shan G, Yu G, et al. Whole genome sequencing of multidrug-resistant Proteus mirabilis strain PM1162 recovered from a urinary tract infection in China. J Glob Antimicrob Resist . 2023; 33: 44-50. doi: 10.1016/j.jgar.2023.02.014

[9] Adebisi YA, Ogunkola IO. The global antimicrobial resistance response effort must not exclude marginalised populations. Trop Med Health. 2023; 51(1): 33. doi: 10.1186/s41182-023-00524-w

[10] Daniel WW. Biostatistics: A Foundation for Analysis in the Health Sciences . 7th ed. New York, NY: John Wiley & Sons; 1999.

[11] Nwankwo U, Chinenye E, Joachim E, Ikechukwu O. Prevalence of Uropathogens and Associated Risk Factors in Urinary Tract Infection in Pregnant Women Attending Antenatal Clinic in a Teaching Hospital in Awka, Nigeria. J Adv Microbiol. 2024; 24(4): 104-114. doi: 10.9734/jamb/2024/v24i4819

[12] Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing . 21st informational supplement. CLSI document M100-S21. Wayne, PA: Clinical and Laboratory Standards Institute; 2011.

[13] Baimakhanova B, Sadanov A, Trenozhnikova L, et al. Understanding the burden and management of urinary tract infections in women. Diseases . 2025; 13(2): 59. doi: 10.3390/diseases13020059

[14] Bhugra A, Gachinmath S. Significant bacteriuria among requested repeat urine samples and its clinical correlation. Iran J Microbiol. 2021; 13(5): 592-601. doi: 10.18502/ijm.v13i5.7421

[15] Assouma FF, Sina H, Adjobimey T, et al. Susceptibility and virulence of Enterobacteriaceae isolated from urinary tract infections in Benin. Microorganisms. 2023;11(1):213. doi: 10.3390/microorganisms11010213

[16] Martin RM, Bachman MA. Colonization, infection, and the accessory genome of Klebsiella pneumoniae. Front Cell Infect Microbiol. 2018; 8: 4. doi: 10.3389/fcimb.2018.00004

[17] Mouanga-Ndzime Y, Bisseye C, Longo-Pendy NM, et al. Trends in Escherichia coli and Klebsiella pneumoniae urinary tract infections and antibiotic resistance over a 5-year period in southeastern Gabon. Antibiotics. 2024; 14(1): 14. doi: 10.3390/antibiotics14010014

[18] Tilahun M, Sharew B, Shibabaw A. Antimicrobial resistance profile and associated factors of hospital-acquired gram-negative bacterial pathogens among hospitalized patients in northeast Ethiopia. BMC Microbiol. 2024; 24(1): 339. doi: 10.1186/s12866-024-03485-0

[19] Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of antibiotics and antibiotic resistance, and their impacts on drug development: A narrative review. Pharmaceuticals. 2023; 16(11): 1615. doi: 10.3390/ph16111615

[20] Jelly P, Verma R, Kumawat R, et al. Occurrence of urinary tract infection and preventive strategies practiced by female students at a tertiary care teaching institution. J Educ Health Promot. 2022; 11: 122. doi: 10.4103/jehp.jehp_750_21

[21] Genovese C, D’Angeli F, Di Salvatore V, Tempera G, Nicolosi D. Streptococcus agalactiae in pregnant women: Serotype and antimicrobial susceptibility patterns over five years in Eastern Sicily (Italy). Eur J Clin Microbiol Infect Dis. 2020; 39(12): 2387-2396. doi: 10.1007/s10096-020-03992-8

[22] Yamani LN, Astutik E, Qurniyawati E, Lusida MI, Getaneh Y, Kelly M. Associations between socio-demographics, sexual knowledge and behaviour, and sexually transmitted infections among reproductive-age women in Southeast Asia: Demographic Health Survey results. BMC Public Health. 2025; 25(1): 738. doi: 10.1186/s12889-025-21962-7

[23] Murewanhema G, Musuka G, Moyo P, Moyo E, Dzinamarira T. HIV and adolescent girls and young women in sub-Saharan Africa: A call for expedited action to reduce new infections. IJID Reg. 2022; 5: 30-32. doi: 10.1016/j.ijregi.2022.08.009

[24] Kumwenda P, Semu P. Characterization of urinary tract infections among females at a tertiary hospital in Malawi: A retrospective study. BMC Infect Dis. 2025; 25(1): 466. doi: 10.1186/s12879-025-10842-5

[25] Laupland KB, Edwards F, Harris PN. Proteus species bloodstream infections: Comparative epidemiology of three species. Diagn Microbiol Infect Dis . 2024; 109(2): 116286. doi: 10.1016/j.diagmicrobio.2024.116286

[26] Isukuru EJ, Opha JO, Isaiah OW, Orovwighose B, Emmanuel SS. Nigeria’s water crisis: Abundant water, polluted reality. Clean Water. 2024; 2: 100026. doi: 10.1016/j.clwat.2024.100026

[27] Akaishi T. Post-toilet wiping style is associated with the risk of urinary tract infection in women. Cureus. 2024; 16(4): e58107. doi: 10.7759/cureus.58107

[28] Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol . 2019; 11: 1756287219832172. doi: 10.1177/1756287219832172

[29] Kayode A, Okunrounmu P, Olagbende A, et al. High prevalence of multiple drug resistant enteric bacteria: Evidence from a teaching hospital in Southwest Nigeria. J Infect Public Health. 2020; 13(4): 651-656. doi: 10.1016/j.jiph.2019.08.014

[30] Zhuang M, Yan W, Xiong Y, et al. Horizontal plasmid transfer promotes antibiotic resistance in selected bacteria in Chinese frog farms. Environ Int. 2024; 190: 108905. doi: 10.1016/j.envint.2024.108905

[31] Castaneda-Barba S, Top EM, Stalder T. Plasmids, a molecular cornerstone of antimicrobial resistance in the One Health era. Nat Rev Microbiol. 2024; 22(1): 18-32. doi: 10.1038/s41579-023-00926-x

[32] Nwaka ON, Franca ON. 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: Transferable resistant genes in Proteus species. Pak J Health Sci. 2023; 4(12): 140-146. doi: 10.54393/pjhs.v4i12.1183