Prevalence of AcrAB-TolC efflux pump among Proteus mirabilis isolated from cystitis patients in Hilla City, Iraq

Background: Proteus mirabilis is a prevalent profiteer pathogen that causes the Spartan human ailment. It has been identified as a urinary tract infection (UTI) etiological agent that adheres to uroepithelial cells and the catheter surface. The most important efflux system in P. mirabilis, acrAB-to1C, is elaborated not merely in antimicrobial conflict but also in ferocity. Objectives: The current research conducted to look into the antibiotic sensitivity profile and acrAB-to1C efflux pump genes occurrence among P. mirabilis isolated from UTI patients. Materials and Methods: 515 urine cases were gathered from UTI patients, who visited urology consultancy clinics of three main hospitals and private clinic labs in Hilla City, Iraq. All mid-stream urine samples were cultured on diagnostic agars for P. mirabilis primary recognition and finally confirmed by16S rRNA gene PCR-sequencing. Antibiotic sensitivity was performed according to CLSI (2021), and then PCR detection of acrAB-to1C efflux pumps genes was observed. Results: The occurrence of P. mirabilis in the studied cases was 10.5% with 100% swarming isolates. The recovered isolates were extremely resistant to cefotaxime (100%), doxycycline (88.6%), minocycline (75.7%), and amoxicillin-clavulanic acid (67.1%). In contrast, the isolates showed nonresistance to pipracillin-tazabactam (0%), meropeneme (0%) and tinier resistance to amikacine (1.4%), imipeneme (2.9%), levofloxacine (4.2), and ofloxacin (5.7%), MDR rate was 96%. Molecular investigation using PCR, revealed acrA, acrB, and tolC genes with a prevalence of 51.4%, 61.4%, and 51.4%, respectively. Conclusion: These findings emphasize the significant title role of acrAB-to1C efflux impel in increasing antibiotic tolerance in P. mirabilis with a high incidence of MDR, so the future insights may need to focus on efflux pumps inhibitor-antibiotic combination treatment as a preventive device.