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Identification of Proteus morganii and distinction from other Proteus species.

The identification of Proteus morganii in the clinical laboratory is complicated by the differences in incidence of hydrogen sulfide (H2S) production recorded by different sources. Since this quality appeared to be a frequent feature of strains of P. morganii at the author's center, all isolates of this species were studied over a six-month period. During this time, 12 of 21 were found to produce scant H2S in Kligler's iron agar (KIA) and triple-sugar iron (TSI) agar butts. The strains were, in every respect, biotypical, and were easily distinguished from other species of Enterobacteriaceae by biochemical study. They also possessed the features of high resistance to cephalothin and ampicillin and relative sensitivity to tetracycline, unlike strains of Proteus mirabilis. It is concluded that weak H2S production in TSI or KIA medium is a frequent normal characteristic of P. morganii, and its presence should not deter microbiologists from correctly identifying isolates manifesting this quality.

Anti-Bacterial Agents

Transduction of a Proteus vulgaris strain by a Proteus mirabilis bacteriophage.

Only Proteus vulgaris strain PV127 out of many P. vulgaris, P. morganii and Providence strains was transduced to kanamycin resistance by high-frequency transducing variants, 5006MHFTk and 5006MHFTak, of phage 5006M, a general transducing phage for P. mirabilis strain PM5006. The phages adsorbed poorly to strain PV127 and did not form plaques. The transduction frequency of PV127 by these phages was 5 x 10(-8)/p.f.u. adsorbed. Phage 5006M increased the transduction frequencies. Abortive transductants were not detected. Transductants segregated kanamycin-sensitive clones at high frequency and this, together with data from the inactivation of transducing activity of lysates by ultraviolet irradiation, indicated that transduction was by lysogenization. The general transducing property of the phages was not expressed in transductions to auxotrophs of PV127. Transductants (type I) resulting from low multiplicities of phage input adsorbed phage to the same extent as PV127. This suggested a defect in the transducing particles (or host) because single phage 5006M infection converted strain PM5006 to non-adsorption of homologous phage. Type I transductants did not liberate phage, suggesting a defective phage maturation function. Transductants (type II) which arose from higher multiplicities of phage input did not adsorb phage, indicating possible heterogeneity among transducing particles. Phage derived from type II transductants adsorbed poorly to PV127 and transduced it to kanamycin resistance at frequencies similar to those of phages 5006MHFTk and 5006MHFTak, ruling out host-controlled modification as a cause of the low transduction frequencies. This phage transduced PM5006 to antibiotic resistance at high frequencies but generalized transduction was again not detected. It was suggested that general transduction could be performed by particles which, due to a different composition and/or mode of chromosomal integration, made material they carried susceptible to host-cell modification.

Bacteriophages

[Resistance of clinical strains of Proteus to various beta-lactam antibiotics].

Sensitivity of Proteus clinical strains to benzylpenicillin, ampicillin and ceporin, as well as the dynamics and stability of the drug resistance was studied. It was found that the beta-lactamides were active against Proteus, ceporin being the most effective antibiotic. Strains resistant simultaneously to 2 or 3 drugs were also resistant to higher concentrations of each of them. The Proteus cultures isolated from various pathological materials did not differ by their sensitivity to benzylpenicillin and ceporin, while the strains isolated from the patient urine were least sensitive to ampicillin. The cultures of Proteus vulgaris were more resistant to the beta-lactamides as compared tcal material were more resistant to benzylpenicillin and ceporin as compared to the cultures in the H-form. No increase in the number of the Proteus strains resistant to benzylpenicillin, ampicillin or ceporin was observed within 1968-1973. The Proteus resistance to ampicillin and ceporin was not stable and was lost on storage. Reversion to sensitivity depended on the individual properties, the period of storage and the resistance level. The studies showed that the clinical strains of Proteus preserved their sensitivity to the above beta-lactame antibiotics which provided their recommendation for therapy of Proteus infections.

Ampicillin

[Beta-lactamase activity of bacteria of the genus Proteus].

beta-Lactamases of Proteus and their role in the mechanism of the microbe resistance to penicillins and ceporin were studied. It was found that the beta-lactamase of Proteus had low activity and were produced by both beta-lactamide resistant and sensitive clinical strains of Proteus. The resistant cultures of Proteus produced enzymes more frequently (3.4--5 times) than the sensitive ones. The synthesis of beta-lactamase in the clinical Proteus strains was inducable. The high induction coefficient was achieved only in the presence of high concentrations of the inductor. No significant dependence of the culture sensitivity level of ampicillin and ceporin on the induction level was observed. The most significant part of the constitutive enzyme in Proteus was intracellular, while that of the inducable enzyme was extracellular. No correlative dependence between the culture resistance levels to penicillins and ceporin and the enzyme activity was noted. The beta-lactamase activity was not found in the transconjugants with the in vitro acquired R-factor controlling the ampicillin and ceporin resistance, as well as in the resistant mutants selected on the media with increasing concentrations of the above antibiotics. Induction of beta-lactamase synthesis was not found in these strains either. The ability of Proteus to synthesize beta-lactamase can be lost on the strain storage under laboratory conditions which was not always accompanied by reduction of the culture sensitivity to ampicillin and ceporin. The enzymatic destruction of beta-lactamides was not the main mechanism of Proteus resistance to the above antibiotics.

Amidohydrolases

[Mechanisms of Proteus resistance to chloramphenicol].

Data on chloramphenicol sensitivity of clinical Proteus strains isolated within 1970--1975 and some mechanisms of their resistance to this antibiotic are presented. It was found that most of the Proteus strains (62.82 +/- 2.15 per cent) were resistant to chloramphenicol. 75 per cent of the isolates had resistance of transmissive character. Resistance of the Proteus cultures to chloramphenicol was not a stable feature and was lost during storage under laboratory conditions. Direct correlation between stability of the antibiotic resistance in the Proteus, the resistance level and the period of the culture storage was found. It was shown that the transmissive resistance to chloramphenicol in the Proteus cultures was due to synthesis of a highly active constituitive chloramphenicol-inactivating enzyme. Direct relation between the Proteus resistance level to chloramphenicol and the rate of the enzyme synthesis was noted. A number of the Proteus strains phenotypically sensitive to this antibiotic was capable of its inactivation. Still, the activity of the enzyme was low. The rate of the enzyme synthesis and the level of the acquired resistance in the chloramphenicol resistant mutants depended on the presence or absence of the enzyme in the cells of the initial sensitive strain. The capacity for chloramphenicol accumulation in a number of the chloramphenicol resistant mutants of the Proteus was decreased.

Chloramphenicol

Extensive segments of the Escherichia coli K12 chromosome in Proteus mirabilis diploids.

Various Escherichia coli K12 Hfr donors transfer at low frequency portions of the E. coli genome to Proteus mirabilis. By remating such Proteus hybrids with the same or a different E. coli Hfr strain, other genetic characters could be added to yield diploid Proteus hybrids which contained more than 30 percent of the E. coli genome. The extent of the E. coli genetic material in these unstable Proteus diploid hybrids included segments with the following selected markers: gal, lac, ara, mel, mtl, and malA. Unselected markers known to map throughout this region of the chromosome were also detected in these hybrids. Among the markers expressed in Proteus hybrids with the E. coli malA region was the receptor site for coliphage lambda. Although plaques were not seen, lambda was adsorbed by the Proteus hybrids. Examination of DNA from the various Proteus hybrids by CsCl density gradient centrifugation showed a satellite component of E. coli DNA with a size that corresponded to the extent of the E. coli genome present as determined by genetic analysis.

Centrifugation, Density Gradient

Detection and antimicrobial susceptibility patterns of Salmonella enterica subsp. arizonae and Proteus spp. associated with gastrointestinal disease in rescued hedgehogs (Erinaceus europaeus).

Western European hedgehogs (Erinaceus europaeus) are frequently admitted to wildlife rehabilitation centres, where infectious diseases may affect recovery and raise One Health concerns. This study aimed to identify bacterial isolates recovered from hedgehog samples submitted for suspected gastrointestinal infection and to characterise their antimicrobial susceptibility profiles. Five bacterial isolates were analysed using the MicroScan WalkAway Plus® system with the Neg-Urine-Combo 98 panel, and the results were interpreted in accordance with EUCAST guidelines. The identified bacteria included one isolate of Salmonella enterica subsp. arizonae, three isolates of Proteus mirabilis and one isolate of Proteus penneri. The Salmonella enterica subsp. arizonae isolate was susceptible to all antimicrobials for which a valid result was obtained. Proteus spp. isolates were susceptible to cefotaxime, nalidixic acid, ciprofloxacin, levofloxacin, norfloxacin, amikacin, gentamicin, tobramycin, aztreonam, cefoxitin, ceftazidime and fosfomycin. However, resistance was observed to amoxicillin-clavulanic acid, ampicillin, ertapenem, meropenem, trimethoprim-sulfamethoxazole, cefuroxime, piperacillin-tazobactam, colistin and nitrofurantoin, with the latter two showing resistance in all Proteus spp. The Proteus penneri isolate displayed the broadest resistance profile, including resistance to several β-lactams, carbapenems. As expected, all Proteus spp. showed intrinsic non-susceptibility to colistin and nitrofurantoin. Although the Salmonella enterica subsp. arizonae isolate was susceptible to the tested agents, Proteus spp. from hedgehog samples may display relevant antimicrobial resistance (AMR) patterns. Therefore, continuous bacteriological monitoring and antimicrobial susceptibility testing are important in wildlife rehabilitation settings to guide treatment decisions and support One Health surveillance.

Antimicrobial resistance

Penicillin-binding proteins in Proteus species.

Penicillin-binding proteins in three species of Proteus, Proteus mirabilis, P. morganii, and P. rettgeri, were investigated by sodium dodecyl sulfate-polyacrylamide slab gel electrophoresis. Penicillin-binding proteins in these Proteus species were compared with those in Escherichia coli K-12. An approximate correlation between penicillin-binding proteins in E. coli and those in Proteus species was shown by several criteria: electrophoretic mobilities; affinities of several beta-lactam antibiotics which show characteristic patterns of binding to penicillin-binding proteins in E. coli; relation between affinities of antibiotics to the proteins and effects on morphological changes in Proteus species; location of beta-lactamase activity among penicillin-binding proteins; and thermostability. The electrophoretic mobilities and several other characteristics of penicillin-binding proteins among the Proteus species examined were found to be similar from species to species and differed only slightly from those of E. coli.

Bacterial Proteins

Resistance to beta-lactam antibiotics Proteus strains.

A total of 218 Proteus strains isolated from clinical sources were tested for their susceptibility to three penicillins and two cephalosporins. The ability to beta-lactamase production was examined in 36 of these strains. Proteus mirabilis strains were generally more susceptible to cephalosporins than to penicillins, whereas indole-positive Protei were almost uniformely resistant to cephalosporins as well as to ampicillin and benzylpenicillin but susceptible to carbenicillin. Fairly good correlation was found between the amount and hydrolytic soectryn if beta-lactamase activity and the pattern of resistance to penicillins and cephalosporins in the strains examined. Some observations indicate, however, that the resistance of Proteus bacilli to this group of antibiotics is partly related to permeability barriers in bacterial cell. About 37% of Proteus strains transferred their ampicillin resistance to E. coli K12. Beta-lactamase activities mediated by R plasmids in E. coli cultures were 1.5 to 5 times higher than in respective Proteus donors.

Ampicillin

[Synergism of colistin and sulfonamide in proteus species (author's transl)].

In agar diffusion testing of Proteus mirabilis strains sensitive to sulfonamide a synergistic effect of colistine (C) and sulfonamide (S) was demonstrated. By quantitative evaluation these results were confirmed in 100 strains of Proteus mirabilis and 100 strains of indol-positive Proteus spp. using broth dilution method. Combining 1 part C with 10 parts S the mean increase in sulfonamide sensitivity was enhanced fourfold. Increasing the inoculum sensitivity of Proteus against the combination of C and S was still found to range within therapeutic blood levels. Therefore in treatment of Proteus infection the positive synergistic effect of C+S should be taken into consideration.

Colistin

[Investigations made to test the demarcation line method (DLM) after Dienes for its suitability in the epidemiology of Proteus mirabilis (author's transl)].

In 1946, DIENES observed that non-identical Proteus-strains, when swarming towards each other, were froming distinctly demarcated lines ("DIENES' phenomenon", demarcation (=AGL) phenomenon). Strains of the same origin were amalgamating without demarcation. In 1970, STURDZA studied this phenomenon and commented on its relevance for the epidemiology of nosocomial Proteus-infections. An increased number of Proteus-infections in Berlin was the reason that this procedure was tested for epidemiological purposes. Approx. 300 Proteus mirabilis-strains, tested on normal meat fluid agar, could be divided into 52 AGL-groups. When tested by several investigators, the coordination to any AGL-group seemed to be very subjective. Consequently, a DNase-agar with o-toluidinblue as an indicator, as had been mentioned by CHAMBERS in 1975, was used in order to give a more exact demonstration of AGL. This resulted in a reduction from 52 to 42 AGL-groups. Another 140 newly isolated Proteus-strains belonged to the 42 known as well as to another 42 new AGL-groups. Whether these 84 AGL-groups possess the constancy which is imperative for practical purposes, is however, still rather doubtful.

Agar

[Change in the quantity of coliform and Proteus bacteria during the ripening of raw, nonperishable meat products].

Studied were the changes in the amount of coliform and Proteus bacteria in the production of raw-dried and raw-smoked unperishable meat products, employing model testing procedures of experimentally contaminated meat products with Escherichia coli and Bacterium proteus, through following up the changes in the counts of coliform and Proteus bacteria in batches of regular production, and by the investigation of raw meat samples of varying moisture content. The studies were carried out at eight enterprises working under different technologic conditions. A total of twenty series of model experiments were carried out with artificially contaminated batches of products as well as twenty-one series of experiments with batches of regular production, and some 93 meat products, dried to a various extent, were sampled. Results showed that during the ripening process with unperishable meat products the reduce in the numbers of coliform bacteria is more intense than the decrease in the Proteus organisms. The process of smoking did not change the amount of these microbes. In unperishable raw meat products that meet the requirements of the Bulgarian State Standard coliforms are found in 43 per cent of the samples, and Proteus bacteria are not present.

Animals

Assessment of technique for rapid detection of Escherichia coli and Proteus species in urine by head-space gas-liquid chromatography.

A test depending on the production of ethanol by Escherichia coli from lactose and dimethyl disulfide by Proteus spp. from methionine in the early exponential phase of growth and the detection of these products by head-space gas-liquid chromatography has been applied to 75 specimens of urine selected to provide the most stringent trial of the test. The test was found to be rapid and reliable for the commonest findings in the microbiological examination of urine. In 3 to 4 h it detected "significant" numbers (greater than 10(5)/ml) of E. coli or of Proteus mirabilis or P. inconstans A, identified as Proteus spp., in 23 urines. It recorded the absence of infection from 32 urines containing borderline or "not significant" numbers of any organism. Significant numbers of other organisms in 13 urines were not mistaken for E. coli or Proteus spp. However, the test was less successful for some less common findings. Klebsiella ozenae in significant numbers in one urine was mistaken for E. coli. P. morganii in significant numbers in one urine was not detected. E. coli or P. mirabilis mixed with significant numbers of another organism were not detected in four out of five urines. The technique is simple and could be automated. It appears to merit more extensive trial in a hospital laboratory and further development to detect and correctly identify more species that cause urinary tract infections.

Chromatography, Gas

Proteus rettgeri infections: a review.

Proteus rettgeri is an aerobic gram-negative bacillus that displays marked resistance against most of the antibiotics presently available. This organism causes infections usually confined to the urinary tract of certain types of compromised patients. Occasionally, it is recovered from soft tissue abscesses, and rarely from the blood and respiratory tract. Proteus rettgeri is notorious for causing nosocomial outbreaks of urinary tract infections in urological and physical medicine wards. Our experience with a patient who had bacteremia with a multi-drug resistant strain of Proteus rettgeri prompted a review of the literature concerning infections with this organism. The salient features of these reports are discussed and summarized. Data on the antibiotic sensitivity of 15 other strains of Proteus rettgeri are included.

Adolescent

Studies of introital colonization in women with recurrent urinary infections. V. The inhibitory activity of normal vaginal fluid on Proteus mirabilis and Pseudomonas aeruginosa.

Normal vaginal fluid from premenopausal volunteers was inoculated with 10 strains of Proteus mirabilis and 14 strains of Pseudomonas aeruginosa at pH's of 4.3, 4.6 and 4.9. All bacteria were killed at pH 4.3. Nine of 10 strains of Proteus mirabilis and 12 of 14 Pseudomonas aeruginosa were killed at pH 4.6. Only 4 of 14 strains of Pseudomonas aeruginosa were killed at pH 4.9, while 8 of 10 strains of Proteus mirabilis were killed at the same pH. We conclude that in comparison to the common 0 group strains of Escherichia coli, vaginal fluid is more bactericidal to Proteus mirabilis and Pseudomonas aeruginosa and that these observations may help explain the relative infrequency of bacteriuria owing to the organisms.

Escherichia coli