الفهرس 
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Abstract
Almost of clinical cases suffering from Proteus mirabilis were isolated from urinary tract infection. The most prevalent diagnosis of isolated samples was renal stone cases as it represented 16.70% followed by hypospadias cases (13.30%). High prevalence of urease, protease and β hemolysins production (100%) were detected among our clinical isolates of P. mirabilis. In comparison with the identification using automated VITEK-2 system (bioMerieux, Marcy I’Etoile, France); our results proved accurate and precised identification. Routine antimicrobial susceptibility testing may uncover a unique pattern of antimicrobial resistance, which frequently serves as early warning of potential disease problems among patients. Almost of P. mirabilis clinical isolates (78.33%) represented MAR index over 0.2. These data gave idea about the common trend of increased antibiotics resistance of uropathogens, which may be due to geographic variation or indiscriminate or sublethal use of antibiotic. Multi drug resistance (73.33%) could be explained by the extensive misuse, overuse, and abuse of different antibiotics by healthcare workers or patients themselves who tend to take antibiotics without medical consultation and prescriptions. The carbapenem antimicrobial agents like imipenem, ertapenem and meropenem has considered as the furthermost effective antimicrobial agent against hospitalized P. mirabilis clinical isolates ESBLs producer and frequently known as the first drug of choice in the serious infections’ treatment generated by ESBL-producing Proteus mirabilis. Biofilm formation of P. mirabilis isolates was achieved in 96.67% and considered a common feature in urinary tract infections in Urology and Nephrology center. Highly prevalence of biofilm production prevented penetration of used antibiotics for the treatment of infected patients by Proteus leading to improper treatment. The use of phenotypic methods for the detection of ESBL-producing P. mirabilis was useful for understanding pathogens. However, these methods had drawbacks that limited their utility for high discrimination among clinical isolates but the genotypic methods were more accurate and highly discriminative between P. mirabilis clinical isolates. Molecular detection of virulence genes by PCR were more accurate and highly discriminative among P. mirabilis clinical isolates. zapA and ureC recorded the highest percentage of the tested virulence genes as they were harbored by all isolates (100%), followed by rsbA (95%), ureA & flaA (93%), hpmA (91.7%) and mrpA (73.3%). The best discrimination was achieved by PCR-based typing methods (ERIC-PCR, BOX-PCR, REP-PCR, RAPD and ISSR). ERIC-PCR was the best method, which differentiated P. mirabilis isolates followed by REP-PCR. The other methods gave medium to high discriminatory efficiency in P. mirabilis. Evaluating of the congruence between typing methods, ERIC-PCR was the best method giving high values for Rands and Wallace. Intra-hospital dissemination of P. mirabilis isolates necessitate the implantation of the infection control measures in Urology and Nephrology center aiming to reduce cost and damage caused by P. mirabilis especially in patients presenting serious health infections. This data not only help in proper treatment of UTI patients but also discourage the indiscriminate use of antibiotics and prevent further development of bacterial drug resistance as extensively drug-resistant (XDR) and pan drug-resistant bacteria (PDR). The data will also help the clinicians to give proper treatment and prescription of most sensitive antibiotic to the patient and avoid use of resistant antibiotics.