Published in PLOS One on 2026-08-11, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Yacob Mohammed Yusuf, Adey Feleke Desta, Desta Ayana, Helen Nigussie Aychegrew, Rajiha Abubeker, Biruk Samson, Tolewak Sura, Atsbeha Gebreegziabxier, Abebe Asseffa Negeri, Chala Bashea, Melak Getu, Gebremedhin Gebremichael, Amete Mihret, Eleni Kidane, Ebisa Mezgebu, Sami Sebri, Gemechu Tadesse, Getachew Tollera, Abraham Ali, Gurja Belay Woldemichael, Zhi Ruan
Source: PLOS One • DOI 10.1371/journal.pone.0355508
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Multidrug-resistant Proteus mirabilis has emerged as an important healthcare-associated pathogen; however, genomic epidemiological data from sub-Saharan Africa remain limited, particularly in military hospital settings. This study aimed to characterize the phenotypic and genomic resistance profiles of P. mirabilis isolates recovered from a military referral hospital in Ethiopia between May 2024 and May 2025. A total of 99 non-duplicate clinical isolates were analyzed using antimicrobial susceptibility testing according to Clinical and Laboratory Standards Institute (CLSI) guidelines, with phenotypic detection of extended-spectrum β-lactamase (ESBL) and carbapenemase production. Whole-genome sequencing was performed on a selected subset of 25 representative ESBL- and/or carbapenemase-associated P. mirabilis isolates to identify resistance genes, determine multilocus sequence types (MLST), analyze plasmid replicons, and reconstruct core-genome phylogeny. Using phenotypic detection, 96.0% of isolates were found to be resistant to at least one third- or fourth-generation cephalosporin, and 99.0% were classified as multidrug-resistant. ESBL production was confirmed in 60.6% (60/99) of isolates, while 6.1% (6/99) demonstrated carbapenemase activity. Genomic analysis revealed diverse ESBL determinants dominated by blaPER-13 (40.0%) and blaVEB-6 (28.0%), with additional detection of blaCTX-M-65. MLST analysis identified nine sequence types, with ST135 predominating (32.0%). Phylogenetic analysis demonstrated moderate genetic heterogeneity, with evidence of multiple lineages circulating within the hospital setting; however, transmission dynamics could not be definitively determined. Plasmid analysis showed a structured replicon distribution dominated by IncQ1 (36.0%) and several Col-type plasmids. These findings demonstrate extensive multidrug resistance associated with diverse ESBL determinants and multiple plasmid replicon types among P. mirabilis isolates in a military healthcare setting. The results highlight the need for strengthened antimicrobial stewardship, improved infection prevention strategies, and integration of genomic surveillance in comparable healthcare environments.
1 Introduction
Antimicrobial resistance (AMR) is a major global public health threat, contributing substantially to morbidity and mortality worldwide. Recent analyses indicate that bacterial AMR has been associated with at least one million deaths annually since 1990, with projections suggesting more than 39 million deaths globally between now and 2050. The burden remains disproportionately high in low- and middle-income countries [1,2]. The increasing prevalence of multidrug-resistant Gram-negative bacteria has further limited therapeutic options and complicated infection management in healthcare settings [2].
Proteus mirabilis is an opportunistic Gram-negative pathogen commonly associated with urinary tract infections, wound infections, and healthcare-associated infections. It is particularly known for its role in complicated urinary tract infections and catheter-associated infections due to its swarming motility, biofilm formation, and urease production [3,4]. Although historically considered less critical than other Enterobacterales, P. mirabilis has increasingly been implicated in multidrug-resistant infections [4,5].
The emergence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales has significantly reduced the efficacy of third-generation cephalosporins. While CTX-M enzymes dominate globally, other ESBL families, including PER and VEB variants, have been reported in various regions [6,7]. In addition, carbapenem resistance among Enterobacterales is of particular concern, as carbapenems are often reserved as last-line agents for severe infections [2,8]. Although carbapenem resistance is more frequently described in Klebsiella pneumoniae and Escherichia coli, recent studies have reported the emergence of carbapenem non-susceptible P. mirabilis [9,10].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Yacob Mohammed Yusuf, Adey Feleke Desta, Desta Ayana, Helen Nigussie Aychegrew, Rajiha Abubeker, Biruk Samson, Tolewak Sura, Atsbeha Gebreegziabxier, Abebe Asseffa Negeri, Chala Bashea, Melak Getu, Gebremedhin Gebremichael, Amete Mihret, Eleni Kidane, Ebisa Mezgebu, Sami Sebri, Gemechu Tadesse, Getachew Tollera, Abraham Ali, Gurja Belay Woldemichael, Zhi Ruan. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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