Prevalence of Proteus spp and its Antibiotic Resistance Pattern in UTI Patients at District Mardan, Khyber Pakhtunkhwa
Abstract
Introduction: Urinary tract infections (UTIs) are a significant global health concern, with Proteus spp emerging as a key pathogen known for its resistance to antibiotics and association with complications like kidney stones. Despite its clinical importance, data on the prevalence and resistance patterns of Proteus spp in District Mardan, Pakistan, remain scarce. This study aimed to determine the prevalence of Proteus spp in UTIs and analyze its antibiotic resistance profile to inform better treatment strategies.
Methodology: A cross-sectional study was conducted from June 2024 to May 2025 at Mardan Medical Complex Hospital, involving 684 UTI patients. Urine samples were collected and processed using standard microbiological techniques, including culture on MacConkey and CLED agar, Gram staining, and biochemical tests. Antibiotic susceptibility was assessed via the Kirby-Bauer disk diffusion method against 19 antibiotics, with resistance interpreted per CLSI guidelines. Statistical analysis was performed using SPSS version 23.0.
Results: Out of 684 samples, 48% (n=329) showed bacterial growth, with Proteus spp accounting for 17% (n=119) of isolates, making it the second most prevalent pathogen after Escherichia coli (22%). The highest resistance was observed against Co-Amoxiclav (93.3%), and Ciprofloxacin (83.2%), while Meropenem (100%) and Fosfomycin (93.3%) were the most effective. Resistance patterns varied significantly by age and gender, with higher resistance noted in middle-aged adults (36–59 years) and males.
Conclusion: The study highlights alarming resistance rates among Proteus spp isolates in District Mardan, particularly to first-line antibiotics. These findings underscore the need for antimicrobial stewardship programs and region-specific treatment guidelines to combat the growing threat of multidrug-resistant UTIs. Further research is recommended to explore genetic mechanisms of resistance and evaluate alternative therapies.
Keywords:
Proteus spp, Urinary tract infections (UTIs), Antibiotic resistance, Multidrug resistance (MDR), Prevalence, Antimicrobial susceptibility, Clinical isolatesDOI
https://doi.org/10.22376/ijpbs.v16i2.57References
1. Kozlovska, G. (2023). Bioecology and pathogenicity of Proteus bacteria: A literature review. Ukrainian Journal of Veterinary Sciences, 14(4), 91–107. https://doi.org/10.31548/veterinary4.2023.91
2. Stolarek, P., Bernat, P., & Różalski, A. (2023). Adjustment in the Composition and Organization of Proteus sppLipids during the Swarming Process. International Journal of Molecular Sciences, 24(22). https://doi.org/10.3390/ijms242216461
3. Foxman, B. (2010). The epidemiology of urinary tract infection. Nature Reviews Urology 2010 7:12, 7(12), 653–660. https://doi.org/10.1038/nrurol.2010.190
4. Hafiz, T. A., Alghamdi, G. S., Alkudmani, Z. S., Alyami, A. S., Almazyed, A., Alhumaidan, O. S., Mubaraki, M. A., & Alotaibi, F. E. (2024). Multidrug-Resistant Proteus sppInfections and Clinical Outcome at Tertiary Hospital in Riyadh, Saudi Arabia. Infection and Drug Resistance, 17, 571–581. https://doi.org/10.2147/IDR.S448335
5. Oliveira, M., Antunes, W., Mota, S., Madureira-Carvalho, Á., Dinis-Oliveira, R. J., & Dias da Silva, D. (2024). An Overview of the Recent Advances in Antimicrobial Resistance. Microorganisms, 12(9), 1–50. https://doi.org/10.3390/microorganisms12091920
6. Magiorakos, A. P., Burns, K., Rodríguez Baño, J., Borg, M., Daikos, G., Dumpis, U., Lucet, J. C., Moro, M. L., Tacconelli, E., Simonsen, G. S., Szilágyi, E., Voss, A., & Weber, J. T. (2017). Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: Guidance from the European Centre for Disease Prevention and Control. Antimicrobial Resistance and Infection Control, 6(1), 1–17. https://doi.org/10.1186/s13756-017-0259-z
7. Yang, X., Chen, H., Zheng, Y., Qu, S., Wang, H., & Yi, F. (2022). Disease burden and long-term trends of urinary tract infections: A worldwide report. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.888205
8. Baimakhanova, B., Sadanov, A., Trenozhnikova, L., Balgimbaeva, A., Baimakhanova, G., Orasymbet, S., Tleubekova, D., Amangeldi, A., Turlybaeva, Z., Nurgaliyeva, Z., Seisebayeva, R., Kozhekenova, Z., Sairankyzy, S., Shynykul, Z., Yerkenova, S., & Turgumbayeva, A. (2025). Understanding the Burden and Management of Urinary Tract Infections in Women. Diseases, 13(2), 1–26. https://doi.org/10.3390/diseases13020059
9. Nwaka, O. N., & Franca, O. N. (2023). 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. Pakistan Journal of Health Sciences, 140–146. https://doi.org/10.54393/pjhs.v4i12.1183
10. Kot, B., Grużewska, A., Szweda, P., Wicha, J., & Parulska, U. (2021). Antibiotic resistance of uropathogens isolated from patients hospitalized in district hospital in central Poland in 2020. Antibiotics, 10(4), 1–14. https://doi.org/10.3390/antibiotics10040447
11. Mo, L., Wang, J., Qian, J., & Peng, M. (2022). Antibiotic Sensitivity of Proteus sppUrinary Tract Infection in Patients with Urinary Calculi. International Journal of Clinical Practice, 2022. https://doi.org/10.1155/2022/7273627
12. Humphries, R. M., Kircher, S., Ferrell, A., Krause, K. M., Malherbe, R., Hsiung, A., & Burnham, C. A. D. (2018). The continued value of disk diffusion for assessing antimicrobial susceptibility in clinical laboratories: Report from the clinical and laboratory standards institute methods development and standardization working group. Journal of Clinical Microbiology, 56(8), 1–10. https://doi.org/10.1128/JCM.00437-18
13. Sanches, M. S., Silva, L. C., Silva, C. R. da, Montini, V. H., Oliva, B. H. D. de, Guidone, G. H. M., Nogueira, M. C. L., Menck-Costa, M. F., Kobayashi, R. K. T., Vespero, E. C., & Rocha, S. P. D. (2023). Prevalence of Antimicrobial Resistance and Clonal Relationship in ESBL/AmpC-Producing Proteus sppIsolated from Meat Products and Community-Acquired Urinary Tract Infection (UTI-CA) in Southern Brazil. Antibiotics, 12(2). https://doi.org/10.3390/antibiotics12020370
14. Hassan, M. A., Abd El-Aziz, S., Elbadry, H. M., El-Aassar, S. A., & Tamer, T. M. (2022). Prevalence, antimicrobial resistance profile, and characterization of multi-drug resistant bacteria from various infected wounds in North Egypt. Saudi Journal of Biological Sciences, 29(4), 2978–2988. https://doi.org/10.1016/j.sjbs.2022.01.015
15. Waqas, M., Khan, Z. A., Ahmad, S., Hamid, M. S., Altaf, M., & Muzzamil Sohail. (2024). Antibiotic Sensitivity and Resistance Patterns of Uropathogens in Peshawar, Pakistan. Journal of Health and Rehabilitation Research, 4(3). https://doi.org/10.61919/jhrr.v4i3.1281
16. Shah, M., Abdullah, S. H., Salman, M., Hayat, M., Sarwar, F., Hassan, R., Jan, N., Saddam, S. A., Rahman, M., & Qazi, Z. (2022). Current Epidemiological Status and Antibiotic Resistance Profile of Urinary Tract Infection. Journal of Bioresource Management, 9(1). https://corescholar.libraries.wright.edu/jbm
17. Hafiz, T. A., Alghamdi, G. S., Alkudmani, Z. S., Alyami, A. S., Almazyed, A., Alhumaidan, O. S., Mubaraki, M. A., & Alotaibi, F. E. (2024). Multidrug-Resistant Proteus sppInfections and Clinical Outcome at Tertiary Hospital in Riyadh, Saudi Arabia. Infection and Drug Resistance, 17, 571–581. https://doi.org/10.2147/IDR.S448335
18. Mohammed, M. A., Alnour, T. M. S., Shakurfo, O. M., & Aburass, M. M. (2016). Prevalence and antimicrobial resistance pattern of bacterial strains isolated from patients with urinary tract infection in Messalata Central Hospital, Libya. Asian Pacific Journal of Tropical Medicine, 9(8), 771–776. https://doi.org/10.1016/j.apjtm.2016.06.011
19. Armbruster, C. E., Brauer, A. L., Humby, M. S., Shao, J., & Chakraborty, S. (2021). Prospective assessment of catheter-associated bacteriuria clinical presentation, epidemiology, and colonization dynamics in nursing home residents. JCI Insight, 6(19), 7–9. https://doi.org/10.1172/jci.insight.144775
20. Khatoon, I., Khanam, S., Azam, A., Qadeer, S., Naz, S., & Hassan, N. U. (2023). Incidence Pattern, Antibiotic Susceptibility Pattern and Associated Risk Factors of Bacterial Uropathogens Among General Population of Pakistan. Infection and Drug Resistance, 16, 4995–5005. https://doi.org/10.2147/IDR.S418045
21. Kwon, J., Yang, M. H., Ko, H. J., Kim, S. G., Park, C., & Park, S. C. (2022). Antimicrobial Resistance and Virulence Factors of Proteus sppIsolated from Dog with Chronic Otitis Externa. Pathogens, 11(10), 1–9. https://doi.org/10.3390/pathogens11101215
22. 22. Alrebish, S. A., Ahmed, N. J., Al Hamed, H., Kumar, A., Yusufoglu, H. S., & Khan, A. H. (2022). Antibiotic Susceptibility of Bacterial Pathogens Stratified by Age in a Public Hospital in Qassim. Healthcare (Switzerland), 10(9), 1–9. https://doi.org/10.3390/healthcare10091757
23. 23. Guo, H., Hildon, Z. J. L., Lye, D. C. B., Straughan, P. T., & Chow, A. (2022). The Associations between Poor Antibiotic and Antimicrobial Resistance Knowledge and Inappropriate Antibiotic Use in the General Population Are Modified by Age. Antibiotics, 11(1), 1–14. https://doi.org/10.3390/antibiotics11010047
24. 24. Hossain, A., Hossain, S. A., Fatema, A. N., Wahab, A., Alam, M. M., Islam, M. N., Hossain, M. Z., & Ahsan, G. U. (2020). Age and gender-specific antibiotic resistance patterns among Bangladeshi patients with urinary tract infection caused by Escherichia coli. Heliyon, 6(6), e04161. https://doi.org/10.1016/j.heliyon.2020.e04161
25. 25. Serry, F. M., El-Masry, E. M., Sadek, R. A., & Girgis, M. M. (2014). Prevalence and antibiotic resistance patterns of Proteus sppisolated from catheter-associated urinary tract infection. Zagazig Journal of Pharmaceutical Sciences, 23(1), 34–43. https://doi.org/10.21608/zjps.2014.38178
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