Description on the Prevalence of Proteus mirabilis through an Integrated Sampling Framework for Health, Food, and Environment in Northeast India and an integrative Review with Reference to One Health Context

Goutam Chowdhury¹Tapan Majumdar²Dilem Modi³Karma G. Dolma⁴Suranjana Chaliha Hazarika⁵Pallab Sharma⁶Samaresh Das⁷Asish Mukhopadhyay¹Anup Kumar Ojha⁸Dr.Madhuchhanda Das^8*Thandavarayan Ramamurthy^1*

• ¹ICMR - National Institute for Research in Bacterial Infections, Kolkata, India
• ²Agartala Government Medical College, Agartala, India
• ³Bankin Pertin General Hospital and Research Institute, Pasighat, India
• ⁴Sikkim Manipal University, Gangtok, India
• ⁵Gauhati Medical College and Hospital, Guwahati, India
• ⁶ICMR - Regional Medical Research Centre Dibrugarh, Dibrugarh, India
• ⁷Centre for Development of Advanced Computing- Kolkata, Kolkata, India
• ⁸Indian Council of Medical Research, New Delhi, India

Foodborne infections caused by different pathogens are a perennial public health problem in India. An uncommon enteric pathogen Proteus mirabilis has been frequently isolated from the hospitalized diarrheal cases and different food and environmental samples collected from four states in Northeast India. This study was aimed at characterizing P. mirabilis isolates to show its etiological importance in public health and also present a review indicating its global prevalence of antimicrobial resistance and detection virulence genes reported from different sources. In this study, we have screened 6298 diarrheal stools from hospitalized patients, 12,305 market foods, 4270 state-specific foods, and 2130 environmental samples. P. mirabilis was isolated and identified by routine microbiological methods. Representative isolates were examined for antimicrobial susceptibility, putative virulence encoding genes by PCR, and in the whole genome sequencing (WGS) analysis. Though the isolation rate of P. mirabilis was low in diarrheal cases (0.4%), its prevalence was detected mostly in environmental samples (3.2%). All the P. mirabilis isolates from diarrheal stools showed resistance to doxycycline, erythromycin, tetracycline. Majority of the P. mirabilis isolates from market foods were resistant to nalidixic acid (92.6%), erythromycin (81.5%), tetracycline, and doxycycline (77.8% each). Isolates from state-specific foods showed higher resistance to quinolone/fluroquinolones, erythromycin, tetracycline, and doxycycline. Meropenem resistance has also been recorded in isolates from market foods and state-specific foods (7.4% and 37.5%, respectively). Of the 15 P. mirabilis isolates tested in the PCR assay, majority of them were positive for pmfA and eight other virulence genes. Though these genes are responsible for UTI, some of them are known to induce diarrhea in vivo. WGS analysis has identified SPI-1 for the first time in P. mirabilis with other virulence genes associated with diarrhea. Considering its presence in several sources, strengthening the One Health approach is important to implement strategies to control the P. mirabilis-mediated infections.