Study the Association of ureA Gene with Biofilm Production and Multidrug Resistance in Proteus Mirabilis Uropathogenic Isolates

Introduction: Proteus mirabilis is a clinically relevant uropathogen due to its urease production, biofilm forming ability, and developing antimicrobial resistance that contribute to poor treatment outcomes of urinary tract infections (UTIs). Objectives: This study investigates the association of ureA gene, biofilm formation and multi-resistance among uropathogenic P. mirabilis isolates. Materials and Methods: 215 Urine samples were obtained from female patients who were diagnosed later with urinary tract infections between September 2025 and February 2025 who attended to Al-Nasr Hospital for Obstetrics and Gynecology, Kirkuk, Iraq. Isolate, Biochemical identification, VITEK 2 identification, antimicrobial susceptibility testing, Biofilm measurement, PCR detection of ureA gene. Results: Out of 215 samples, 17 isolates (7.9%) were confirmed as P. mirabilis. Antibiotic resistance was highest against piperacillin (100%), amoxicillin (88.2%), and colistin (64.7%), while highest susceptibility was observed for meropenem (94.1%) and imipenem (88.2%). MDR accounted for 58.8% (10/17), XDR for 5.9% (1/17), and non-MDR for 35.3% (6/17). Biofilm analysis showed weak (41.2%), moderate (23.5%), strong (5.9%), and non-producers (29.4%). The ureA gene was detected in 76.5% (13/17) of isolates. A clear association was observed between MDR and biofilm formation, particularly in weak and moderate biofilm producers. Conclusions: P. mirabilis isolates were highly resistant to antimicrobials, formed a considerable amount of biofilm and possessed a high frequency of ureA gene, suggesting a close association between virulence and resistance traits.