Antibiotic Suceptibility and Molecular Characterization of Proteus Species in Uterine Postpartum Infections in Benue State, Nigeria

Abstract

Postpartum infections also known as puerperal infections are bacterial infection that occur in women after childbirth. They are relatively common and are among the leading causes of maternal morbidity and mortality. The aim of the study was to assess the antibiotic susceptibility pattern and to characterize Proteus species implicated in uterine postpartum infection in women of child bearing age in the three senatorial zones (A, B & C) in Benue state. The study was conducted across three Zones: Zone A (Katsina Ala), Zone B (Makurdi) and Zone C (Otukpo). A total of 500 hundred clinical samples (high vaginal swab and urine) were collected from women of child bearing age, attending maternity clinics in the hospital facilities and private maternity homes for routine checkup. Standard microbiological procedures were used for sample analysis. Seventy (70) Proteus mirabilis was isolated out of the 500 hundred specimens collected. Fifteen (15) samples were ESBL producers. Antibiotic susceptibility testing revealed high (100%) sensitivity of Proteus mirabilis isolates to Amikacin (Aminoglycoside), Imipenem and Meropenem (carbapenems), and Piperacillin/ Tazobactam (β- lactam/ β- lactamase inhibitor). However, isolates exhibited high resistance to tetracycline and nitrofurantoin. Sensitivity profiles showed that isolates from the Federal Medical Center had high susceptibility to Amikacin 100%, Imipenem (100%), Gentamycin (85.7%), Meropenem (85.7%) and Piperacillin- tazobactam (85.7%). Similar trends were observed in Benue State University Teaching Hospital, where isolates exhibited high susceptibility to Meropenem (100%), Imipenem (95.2%), Amikacin (90.5%) and Ciprofloxacin (81.0%). Federal University of Health Science Teaching Hospital Otukpo and General Hospital Katsina Ala also demonstrated high sensitivity to Meropenem (100%), Imipenem (93.3%), Ciprofloxacin (86.7%) and Amoxicillin (86.7%). Notably, 28.6% of Proteus mirabilis from Benue State University Teaching Hospital were extended-spectrum beta-lactamase (ESBL) producers. Molecular analysis confirmed the presence of TEM, AAC, and qnrA resistance genes in 15 ESBL- producing Proteus mirabilis isolates with qnrA detected in 93.3% and both TEM and AAC genes present in all isolates (100%). Molecular analysis of the isolates revealed genetic clustering, indicating transmission pathways within and across maternity clinic. MEGA BLAST analysis of the16S rRNA sequences showed 100% similarity between isolates and closely related Proteus species. These results align with global studies that have identified similar genetic patterns in bacterial pathogens implicated in postpartum infections, reflecting the dynamic epidemiology of such infections. These findings highlight potential transmission routes of Proteus mirabilis strains within health care facilities, emphasizing the need for urgent and improved infection control measures to reduce postpartum infections in maternity settings.