Molecular characterization of multidrug-resistant Proteus mirabilis isolates from pregnant women with recurrent urinary tract infection in Erbil city, Iraq

Background and Objectives: Urinary tract infections (UTIs) are common in pregnancy and can cause maternal and fetal complications. Proteus mirabilis is a significant pathogen in recurrent UTIs due to its virulence factors. This study investi- gated the virulence genes and antibiotic resistance patterns of P. mirabilis isolates from pregnant women with UTIs in Erbil, Iraq. Materials and Methods: This cross-sectional study (September 2024–January 2025) included 120 urine specimens from pregnant women (15-44 years) with UTI symptoms. Bacterial identification was performed using culture, biochemical tests, as well as the Vitek 2 system. Virulence genes were detected by PCR, and antimicrobial susceptibility was assessed by stan- dard methods. Results: Of the 120 samples, 103 (85.8%) showed bacterial growth; 8 (6.7%) were positive for P. mirabilis, while 95 (79.1%) yielded other bacteria. The most affected age group was 25-34 years (52.5%), predominantly in the second trimester (42.5%) and urban residents (60.8%). Antimicrobial resistance was significant to ampicillin, trimethoprim-sulfamethoxazole, amox- icillin/clavulanic acid, and cephalosporins, although susceptibility was observed with several antibiotics. All P. mirabilis isolates harbored the UreC gene, and 75% possessed the MrpA virulence gene. Conclusion: Multidrug-resistant P. mirabilis with key virulence genes was detected in pregnant women with UTIs. Regular screening and resistance monitoring are essential for effective management.