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Journal of Clinical Microbiology, November 2003, p. 4961-4965, Vol. 41, No. 11
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.11.4961-4965.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Molecular Epidemiology of Proteus mirabilis Infections of the Catheterized Urinary Tract

N. A. Sabbuba,^* E. Mahenthiralingam, and D. J. Stickler

Cardiff School of Biosciences, Cardiff University, Cardiff, United Kingdom

Received 22 April 2003/ Returned for modification 2 June 2003/ Accepted 4 August 2003

Proteus mirabilis compromises the care of many patients undergoing long-term indwelling bladder catheterization. It forms crystalline bacterial biofilms in catheters which block the flow of urine, causing either incontinence due to leakage or painful distention of the bladder due to urinary retention. If it is not dealt with, catheter blockage can lead to pyelonephritis and septicemia. We have examined the epidemiology of catheter-associated P. mirabilis infections by use of pulsed-field gel electrophoresis (PFGE) of NotI restriction enzyme digests of bacterial DNA. This technique was shown to be more discriminatory than the classical phenotypic Dienes typing technique. We demonstrated that each of 42 isolates from diverse environmental sources and 10 of 12 isolates from blood, wound swabs, and mid-stream urine samples of hospitalized patients had distinct genotypes. Examination of a set of 55 isolates of P. mirabilis, each from a different clinical or environmental source, identified 49 distinct genotypes and 43 Dienes types. The index of discrimination was 0.993 for the PFGE method and 0.988 for the Dienes method. Applying the PFGE method to isolates from catheter-associated urinary tract infections confirmed that the strains present in the crystalline catheter biofilms were identical to those isolated from the same patient's urine. An analysis of samples taken during a prospective study of infections in catheterized nursing home patients revealed that a single genotype of P. mirabilis can persist in the urinary tract despite many changes of catheter, periods of noncatheterization, and antibiotic therapy.

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* Corresponding author. Mailing address: Cardiff School of Biosciences, Cardiff University, Main Building, Park Place, Cardiff CF10 3TL, United Kingdom. Phone: 44 290 20876331. Fax: 44 290 20874305. E-mail: Sabbuba{at}cardiff.ac.uk.

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Journal of Clinical Microbiology, November 2003, p. 4961-4965, Vol. 41, No. 11
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.11.4961-4965.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

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