Comparative distribution and antibiotic susceptibility of extended-spectrum beta-lactamase- and non-extended-spectrum beta-lactamase-producing Proteus mirabilis in wound infections at Zainoel Abidin General Hospital, Banda Aceh, Indonesia

Abstract

Background and Aim: Proteus mirabilis, an opportunistic pathogen of the Enterobacteriaceae family, is frequently implicated in wound infections and exhibits significant antibiotic resistance, particularly through the production of extended-spectrum beta-lactamase (ESBL). This study aimed to determine the occurrence and antibiotic susceptibility of ESBL-producing and non-ESBL P. mirabilis isolates in wound infections at Zainoel Abidin General Hospital, Banda Aceh, Indonesia. Materials and Methods: A cross-sectional study was conducted on wound specimens collected between January 2021 and March 2024. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK® 2 Compact system. Statistical analyses were conducted using Chi-square or Fisher statistical analyses significance set at p ≤ 0.05. Results: A total of 153 P. mirabilis isolates were identified, of which 60 (39.22%) were ESBL-producing and 93 (60.78%) were non-ESBL-producing. The highest occurrence was observed in male patients (55% ESBL and 54.84% non-ESBL) and in patients older than 55 years (48.33% ESBL and 38.71% non-ESBL). Antibiotic susceptibility testing revealed that ESBL-producing isolates were highly susceptible to cefoperazone/sulbactam (98.67%), meropenem (98.33%), amikacin (96.67%), and piperacillin/tazobactam (91.67%). Non-ESBL isolates exhibited the highest susceptibility to amikacin (97.85%), cefoperazone/sulbactam (96.77%), piperacillin/tazobactam (91.67%), and ceftazidime (90.32%). Notably, ESBL-producing isolates exhibited resistance to amoxicillin (0%), ampicillin (1.67%), cefotaxime (8.33%), and levofloxacin (10%). Conclusion: The high occurrence of ESBL-producing P. mirabilis, particularly in elderly patients, underscores the need for routine ESBL screening and targeted antibiotic therapy. The observed differences in antibiotic susceptibility between ESBL and non-ESBL isolates highlight the importance of early detection for appropriate antibiotic selection in wound infection management. Continued surveillance and antimicrobial stewardship are crucial in mitigating the impact of antibiotic-resistant P. mirabilis in clinical settings.

Keywords

• antibiotic resistance
• antimicrobial susceptibility
• extended-spectrum beta-lactamase
• proteus mirabilis
• wound infection