Microbiological Characterization and Antibiotic Resistance Profiling of Providencia Spp,: An Emerging Pathogen Isolated From Urinary Tract Infections

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, with Escherichia coli, Klebsiella spp., Proteus spp., and Pseudomonas spp. representing the majority of isolated pathogens in both community and hospital settings. Providencia spp., although historically considered uncommon, are increasingly recognized as opportunistic pathogens. International surveillance studies report that Providencia accounts for \~1-2% of urinary isolates, with higher prevalence (up to 6-12%) in catheter-associated infection. The Providencia genus, nestled within the Enterobacterales order as part of Proteus and Morganella relatives, consists of Gram-negative bacteria that are adept at producing urease . The genus includes 14 distinct species, with Providencia rettgeri, Providencia stuartii, Providencia alcalifaciens, and Providencia hangzhouensis standing out due to their pronounced relevance to human infections. Renowned for their association with urinary tract infections, these pathogens also possess the capability to inflict a broader spectrum of severe ailments, such as ocular diseases,peritonitis, neonatal septicemia or bloodstream infections and meningitis. Providencia stuartii is able to adhere to and invade HeLa-M epithelial cell line. They form biofilms and have several virulence genes . Providencia spp. may be susceptible to third- and fourth-generation cephalosporins, aztreonam, imipenem, and meropenem. Providencia species have variable susceptibilities to fluoroquinolones, aminoglycosides, and trimethoprim- sulfamethoxazole (TMP-SMX). Generally, Providencia spp. are frequently resistant to tetracyclines, penicillins, and first- and second- generation cephalosporins . Providencia spp.are intrinsically resistant to polymyxins and tigecycline, which are considered last- resort antibiotics for other resistant pathogens . In Egypt, several studies have investigated the prevalence of UTI pathogens, consistently reporting E. coli, Klebsiella spp., and Proteus spp. as the most frequent isolates . However, no published Egyptian data specifically describe the prevalence, antimicrobial resistance patterns, or clinical significance of Providencia spp. in UTIs. This gap highlights the need for focused research on Providencia in the Egyptian context. Studying its frequency, antibiotic resistance mechanisms, and clinical relevance would not only provide novel insights but also contribute to improving diagnosis, empirical therapy, and infection control strategies in Egyptian hospitals .