Prevalence of Proteus mirabilis in Clinical Samples of UTI Patients with Rheumatoid Arthritis, Molecular Screening and Antibiotic Susceptibility Tests in Association with Interleukin-8 Analysis .

Abstract

Rheumatoid arthritis (RA) is one of the more common autoimmune diseases, affecting individuals of middle age groups of the population worldwide. The exact cause of RA is not known however, initiation of disease seems to cause by an interaction among genetic susceptibility, environmental triggers, and chance. Different immunological and microbiological studies results support that there could be a link between urinary tract infections (UTI) and RA, the occurrence is found in females more than males, which  mainly caused by microorganisms especially Gram-negative P.mirabilis bacterium aetiopathogenesis of RA which activate inflammation and  production of cytokines and chemokines  as IL-8 an important biomarker of the inflammatory immune response to pathogens. A total of 116 urine samples were collected from urinary tract infection patients with RA from different hospitals in Baghdad (Baghdad Teaching Hospital/ Medical City and Al-Nuaman Teaching Hospital) at a period of study from beginning of September 2023 to the end of March 2024. The clinical urine samples which collected were cultured on blood agar and MacConkey agar. Six of the specimen were identified as P.mirabilis, but only five isolated was confirmed depend on the automated VITEK2 system used for farther identification. Molecular methods using PCR technique targeting 16SrRNA, the results indicated that only 5 isolates was diagnosed as Proteus mirabilis, further diagnosis using UreC gene was done, the results found that out of 6 samples only 2 were positive for identification UreC. The P. mirabilis samples were also characterized for antibiotic resistance and the results showed that Proteus mirabilis isolates1,2,3 and5 resists to 6 different antibiotics(Ampicilline/Sulbactum, Cefotaxime, Gentamicin, Tigecycline with a percentage reach(100%), but Rifampicin and Trimethoprim / Sulphamethazole with a prevalence rate of (80%) respectively. While all these isolates showed sensitivity to7-4 antibiotics Amikacin, Ceftazidime, Ceftolozane, Ciprofloxacin with a percentage of(100%),while Piperacillin/ Tazobactum, Meropenem and Imipenem showed moderately sensitivity with a rate ranging from (80-60%) respectively, with non significant differences (P≥0.05). Haematological and immunological tests for RA patients to detect anti-pathogens antibody like Rheumatoid factor (RF+), also ESR, CRP and Anti-CCP tests were done. The results show positive reaction and increasing the levels of all these tests against pathogens. The level of IL-8 was measured and the mean level was elevated non significantly (P≥0.05) in RA patients with UTI more than control (83.74pg/ml vs 74.09 pg/ml), also the level of IL-8 in RA patients’ sera with UTI who infected by P.mirabilis is increased significantly, it gave mean level (126.3 pg/ml) in their serum.