{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T18:28:21Z","timestamp":1786472901825,"version":"build-2736575974"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Multidrug-resistant\n                    <jats:italic>Proteus mirabilis<\/jats:italic>\n                    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\n                    <jats:italic>P. mirabilis<\/jats:italic>\n                    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 \u03b2-lactamase (ESBL) and carbapenemase production. Whole-genome sequencing was performed on a selected subset of 25 representative ESBL- and\/or carbapenemase-associated\n                    <jats:italic>P. mirabilis<\/jats:italic>\n                    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\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>PER-13<\/jats:sub>\n                    (40.0%) and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>VEB-6<\/jats:sub>\n                    (28.0%), with additional detection of\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M-65<\/jats:sub>\n                    . 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\n                    <jats:italic>P. mirabilis<\/jats:italic>\n                    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.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0355508","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:29:26Z","timestamp":1786469366000},"page":"e0355508","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Genomic epidemiology of multidrug-resistant and ESBL-producing Proteus mirabilis in a military referral hospital in Ethiopia"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2039-2957","authenticated-orcid":true,"given":"Yacob Mohammed","family":"Yusuf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adey Feleke","family":"Desta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desta","family":"Ayana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen Nigussie","family":"Aychegrew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiha","family":"Abubeker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biruk","family":"Samson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tolewak","family":"Sura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsbeha","family":"Gebreegziabxier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abebe Asseffa","family":"Negeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chala","family":"Bashea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melak","family":"Getu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gebremedhin","family":"Gebremichael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amete","family":"Mihret","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Kidane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebisa","family":"Mezgebu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1986-9505","authenticated-orcid":true,"given":"Sami","family":"Sebri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemechu","family":"Tadesse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getachew","family":"Tollera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurja Belay","family":"Woldemichael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"issue":"10325","key":"pone.0355508.ref001","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"CJ Murray","year":"2022","journal-title":"The Lancet"},{"key":"pone.0355508.ref002","unstructured":"World Health Organization. Global antibiotic resistance surveillance report 2025. Geneva, Switzerland. 2025."},{"key":"pone.0355508.ref003","article-title":"Unveiling the hidden arsenal: new insights into Proteus mirabilis virulence in UTIs","author":"A Yang","year":"2024","journal-title":"Frontiers in Cellular and Infection Microbiology"},{"key":"pone.0355508.ref004","doi-asserted-by":"crossref","first-page":"1229194","DOI":"10.3389\/fcimb.2023.1229194","article-title":"Genetic analysis of resistance and virulence characteristics of clinical multidrug-resistant Proteus mirabilis isolates","volume":"13","author":"Y Li","year":"2023","journal-title":"Front Cell Infect Microbiol"},{"key":"pone.0355508.ref005","doi-asserted-by":"crossref","first-page":"571","DOI":"10.2147\/IDR.S448335","article-title":"Multidrug-Resistant Proteus mirabilis Infections and Clinical Outcome at Tertiary Hospital in Riyadh, Saudi Arabia","volume":"17","author":"TA Hafiz","year":"2024","journal-title":"Infect Drug Resist"},{"issue":"4","key":"pone.0355508.ref006","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1128\/CMR.18.4.657-686.2005","article-title":"Extended-spectrum beta-lactamases: a clinical update","volume":"18","author":"DL Paterson","year":"2005","journal-title":"Clin Microbiol Rev"},{"issue":"3","key":"pone.0355508.ref007","doi-asserted-by":"crossref","DOI":"10.1093\/jacamr\/dlab092","article-title":"Extended-spectrum \u03b2-lactamases: an update on their characteristics, epidemiology and detection","volume":"3","author":"M Castanheira","year":"2021","journal-title":"JAC Antimicrob Resist"},{"key":"pone.0355508.ref008","article-title":"An Overview on Phenotypic and Genotypic Characterisation of Carbapenem-Resistant Enterobacterales","author":"AA Rabaan","year":"2022","journal-title":"Medicina"},{"issue":"1","key":"pone.0355508.ref009","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-025-12447-4","article-title":"Dissemination of integrons and carbapenemase-encoding genes among multidrug resistant Proteus mirabilis isolated from urinary tract infections in Egypt","volume":"26","author":"S Zaki","year":"2026","journal-title":"BMC Infect Dis"},{"key":"pone.0355508.ref010","doi-asserted-by":"crossref","first-page":"109487","DOI":"10.1016\/j.envint.2025.109487","article-title":"Genomic analysis of Proteus mirabilis: Unraveling global epidemiology and antimicrobial resistance dissemination - emerging challenges for public health and biosecurity","volume":"199","author":"S Zhang","year":"2025","journal-title":"Environ Int"},{"issue":"1","key":"pone.0355508.ref011","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12920-025-02305-2","article-title":"Benchmarking Illumina and Oxford Nanopore Technologies (ONT) sequencing platforms for whole genome sequencing of bacterial genomes and use in clinical microbiology","volume":"19","author":"S Purushothaman","year":"2026","journal-title":"BMC Med Genomics"},{"key":"pone.0355508.ref012","article-title":"Integrating whole-genome sequencing into antimicrobial resistance surveillance: methodologies, challenges, and perspectives","author":"Y Matsumura","year":"2025","journal-title":"Clin Microbiol Rev"},{"key":"pone.0355508.ref013","unstructured":"CLSI. Performance Standards for Antimicrobial Susceptibility Testing. Malvern, PA, USA: Clinical and Laboratory Standards Institute (CLSI). 2023."},{"issue":"3","key":"pone.0355508.ref014","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"A-P Magiorakos","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"pone.0355508.ref015","author":"S Andrews","year":"2010"},{"issue":"17","key":"pone.0355508.ref016","doi-asserted-by":"crossref","DOI":"10.1093\/bioinformatics\/bty560","article-title":"fastp: an ultra-fast all-in-one FASTQ preprocessor","volume":"34","author":"S Chen","year":"2018","journal-title":"Bioinformatics"},{"key":"pone.0355508.ref017","author":"T Seemann","year":"2017"},{"issue":"14","key":"pone.0355508.ref018","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1093\/bioinformatics\/btu153","article-title":"Prokka: Rapid prokaryotic genome annotation","volume":"30","author":"T Seemann","year":"2014","journal-title":"Bioinformatics"},{"issue":"11","key":"pone.0355508.ref019","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.00483-19","article-title":"Validating the AMRFinder Tool and Resistance Gene Database by Using Antimicrobial Resistance Genotype-Phenotype Correlations in a Collection of Isolates","volume":"63","author":"M Feldgarden","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0355508.ref020","doi-asserted-by":"crossref","first-page":"551","DOI":"10.3389\/fmicb.2018.00551","article-title":"The Applied Development of a Tiered Multilocus Sequence Typing (MLST) Scheme for Dichelobacter nodosus","volume":"9","author":"AM Blanchard","year":"2018","journal-title":"Front Microbiol"},{"issue":"5","key":"pone.0355508.ref021","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1093\/molbev\/msaa015","article-title":"IQ-TREE 2: New Models and Efficient Methods for Phylogenetic Inference in the Genomic Era","volume":"37","author":"BQ Minh","year":"2020","journal-title":"Molecular Biology and Evolution"},{"key":"pone.0355508.ref022","article-title":"Proteus mirabilis in ICU patients: prevalence, risk factors, and future expectations of bloodstream infections","author":"M Afifi","year":"2025","journal-title":"Cureus"},{"issue":"5","key":"pone.0355508.ref023","first-page":"725","article-title":"Incidence of Proteus species in wound infections and their sensitivity pattern in the University of Benin Teaching Hospital","volume":"8","author":"RM Mordi","year":"2009","journal-title":"Afr J Biotechnol"},{"issue":"2","key":"pone.0355508.ref024","doi-asserted-by":"crossref","first-page":"71","DOI":"10.20408\/jti.2025.0019","article-title":"Surgical site infections: a comprehensive review","volume":"38","author":"AR Rezaei","year":"2025","journal-title":"J Trauma Inj"},{"issue":"1","key":"pone.0355508.ref025","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3390\/antibiotics15010069","article-title":"Epidemiology of ESBL-Producing, Carbapenem-Resistant, and Carbapenemase-Producing Enterobacterales in Southern Africa","volume":"15","author":"P Ntshonga","year":"2026","journal-title":"Antibiotics (Basel)"},{"issue":"1","key":"pone.0355508.ref026","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s40001-024-02267-8","article-title":"Extended-spectrum \u03b2-lactamase production and antimicrobial resistance among Enterobacteriaceae causing clinical infections in Africa: a systematic review and meta-analysis (2012-2020)","volume":"30","author":"GK Abay","year":"2025","journal-title":"Eur J Med Res"},{"key":"pone.0355508.ref027","article-title":"Regional variation of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, fluoroquinolone-resistant Salmonella enterica and methicillin-resistant Staphylococcus aureus among febrile patients in sub-Saharan Africa","author":"RM Moirongo","year":"2020","journal-title":"Front Microbiol"},{"key":"pone.0355508.ref028","article-title":"Threats across boundaries: the spread of ESBL-positive Enterobacteriaceae bacteria and its challenge to the \u201cone health\u201d concept","author":"S Zhang","year":"2025","journal-title":"Frontiers in Microbiology"},{"key":"pone.0355508.ref029","article-title":"The genotype-to-phenotype dilemma: How should laboratories approach discordant susceptibility results?","author":"R Yee","year":"2021","journal-title":"Journal of Clinical Microbiology"},{"key":"pone.0355508.ref030","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1128\/CMR.00036-08","article-title":"AmpC \u0392-Lactamases","author":"GA Jacoby","year":"2009","journal-title":"Clinical Microbiology Reviews"},{"issue":"1","key":"pone.0355508.ref031","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12866-025-04651-8","article-title":"Genomic epidemiology of antimicrobial resistance in Proteus mirabilis: core genome and plasmid-mediated drivers","volume":"26","author":"P Zhang","year":"2025","journal-title":"BMC Microbiol"},{"issue":"3","key":"pone.0355508.ref032","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1128\/MMBR.00020-10","volume":"74","author":"C Smillie","year":"2010","journal-title":"Microbiology and Molecular Biology Reviews"},{"issue":"5","key":"pone.0355508.ref033","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1093\/jac\/dkx488","article-title":"Plasmids carrying antimicrobial resistance genes in Enterobacteriaceae","volume":"73","author":"M Rozwandowicz","year":"2018","journal-title":"J Antimicrob Chemother"},{"issue":"5","key":"pone.0355508.ref034","doi-asserted-by":"crossref","DOI":"10.1128\/microbiolspec.UTI-0017-2013","article-title":"Proteus mirabilis and Urinary Tract Infections","volume":"3","author":"JN Schaffer","year":"2015","journal-title":"Microbiol Spectr"},{"key":"pone.0355508.ref035","article-title":"Heavy metal driven co-selection of antibiotic resistance in soil and water bodies impacted by agriculture and aquaculture","author":"C Seiler","year":"2012","journal-title":"Frontiers in Microbiology"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:29:33Z","timestamp":1786469373000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355508"}},"subtitle":[],"editor":[{"given":"Zhi","family":"Ruan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355508","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]}}}