Proteus mirabilis in Urinary Tract Infections: Pathogenesis, Epidemiology and Antimicrobial Resistance

Abstract

Proteus mirabilis is an important opportunistic uropathogen responsible for complicated urinary tract infections (UTIs), particularly catheter-associated urinary tract infections (CAUTIs) and healthcare-associated infections. The increasing clinical significance of this microorganism is associated with population aging, the widespread use of medical biomaterials, and the growing antimicrobial resistance among hospital-acquired strains. Urease production, swarming motility, and the ability to form crystalline biofilms play a crucial role in the pathogenesis of infection, contributing to chronic infection, struvite stone formation, and catheter encrustation.

The aim of this study was to review current data regarding the epidemiology, virulence mechanisms, antimicrobial susceptibility, and contemporary treatment strategies for UTIs caused by P. mirabilis , with particular emphasis on global antimicrobial resistance trends. Analysis of the available literature indicates a worldwide increase in the prevalence of multidrug-resistant (MDR) strains, including isolates producing extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, and carbapenemases. Crystalline biofilm formation remains a major clinical challenge, as it limits the efficacy of antimicrobial therapy and promotes recurrent infections.

Current therapeutic strategies include targeted antimicrobial therapy based on antimicrobial susceptibility testing, as well as the development of approaches targeting biofilm formation and bacterial virulence mechanisms. Effective prevention and management of P. mirabilis infections require continuous monitoring of local antimicrobial susceptibility patterns, strict control of healthcare-associated infections, and further development of novel therapeutic strategies.