<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">AiM</journal-id><journal-title-group><journal-title>Advances in Microbiology</journal-title></journal-title-group><issn pub-type="epub">2165-3402</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/aim.2015.57057</article-id><article-id pub-id-type="publisher-id">AiM-58301</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biomedical&amp;Life Sciences</subject></subj-group></article-categories><title-group><article-title>
 
 
  Genotyping of New and Old &lt;i&gt;Proteus mirabilis&lt;/i&gt; Isolates from Mansoura Hospitals in Egypt by &lt;i&gt;rpoB&lt;/i&gt; Sequence Analysis
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>ohamed</surname><given-names>Mohamed Adel El-Sokkary</given-names></name><xref ref-type="aff" rid="aff1"><sub>1</sub></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Microbiology Department, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt</addr-line></aff><author-notes><corresp id="cor1">* E-mail:</corresp></author-notes><pub-date pub-type="epub"><day>03</day><month>07</month><year>2015</year></pub-date><volume>05</volume><issue>07</issue><fpage>549</fpage><lpage>554</lpage><history><date date-type="received"><day>15</day>	<month>June</month>	<year>2015</year></date><date date-type="rev-recd"><day>accepted</day>	<month>24</month>	<year>July</year>	</date><date date-type="accepted"><day>27</day>	<month>July</month>	<year>2015</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Sequence analysis of the RNA polymerase B subunit encoding gene (
  rpoB
  ) has been proposed as a useful tool for bacterial identification. This method has been implemented to differentiate five well-defined Proteus species: 
  P. mirabilis
  ,
   P. hauseri
  ,
   P. penneri
  ,
   P. vulgaris
  , and 
  P. myxofaciens.
   In this study, we evaluated the usefulness of 
  rpoB
   sequencing for intraspecies discrimination of 
  P. 
  mirabilis
  . The sequence of 
  rpoB
   909 bp region was analyzed in 15 newly isolated strains and 5 of 8 years old isolates from different clinical sources. Three respective groups were obtained. The first group included 13 of the new strains showing similarity with 
  Proteus mirabilis
   (ATCC 29906) strain. The second group including 3 of the old strains differs from the first group with a divergence of 0.22%. Group 3 contains only a single new strain 33. The sequence of this strain shows differences in the 
  rpoB
   909 bp region analyzed from the members of group 1 and the second group by 1.65% and 1.87% divergence respectively. According to our results, genetic differences could be detected within the 
  P. 
  mirabilis
   species. Therefore much more effort should be made to re-evaluate 
  rpoB
   method and validate its usefulness as a molecular diagnostic method.
 
</p></abstract><kwd-group><kwd>Proteus</kwd><kwd> Genetic Analysis</kwd><kwd> &lt;i&gt;rpoB&lt;/i&gt; Sequencing</kwd><kwd> Ribotyping</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>As a member of the Enterobacteriaceae, Proteus sp. constitutes a part of the normal flora of the intestinal tract of both humans and animals. Opportunistic infections, commonly found in the human intestinal tract, are usually associated with Proteus. Catheterization and surgery of the urinary tract are considered as predisposing factors for urinary tract infections in hospital patients.</p><p>The genus Proteus consists of five species (P. hauseri, Proteus myxofaciens, Proteus penneri, Proteus mirabilis, and Proteus vulgaris) [<xref ref-type="bibr" rid="scirp.58301-ref1">1</xref>] . Three species namely Proteus mirabilis, P. penneri and P. vulgaris are associated with most common causes of complicated urinary tract infections [<xref ref-type="bibr" rid="scirp.58301-ref2">2</xref>] [<xref ref-type="bibr" rid="scirp.58301-ref3">3</xref>] and are notable for their swarming abilities, which are directly linked to their ability to cause diseases [<xref ref-type="bibr" rid="scirp.58301-ref2">2</xref>] [<xref ref-type="bibr" rid="scirp.58301-ref4">4</xref>] . Proteus mirabilis strains account for about 10% of uncomplicated urinary tract infections [<xref ref-type="bibr" rid="scirp.58301-ref5">5</xref>] , and they are one of most common causes of nosocomial urinary tract infections and sepsis in patients [<xref ref-type="bibr" rid="scirp.58301-ref3">3</xref>] [<xref ref-type="bibr" rid="scirp.58301-ref6">6</xref>] . Furthermore, P. mirabilis has been implicated in cases of empyema [<xref ref-type="bibr" rid="scirp.58301-ref7">7</xref>] , neonatal meningoencephalitis [<xref ref-type="bibr" rid="scirp.58301-ref8">8</xref>] , osteomyelitis [<xref ref-type="bibr" rid="scirp.58301-ref9">9</xref>] , and bacteremia [<xref ref-type="bibr" rid="scirp.58301-ref10">10</xref>] .</p><p>In Egypt, P. mirabilis constitutes the third most commonly isolated pathogen of urinary tract infections after Escherichia coli and Klebsiella pneumoniae [<xref ref-type="bibr" rid="scirp.58301-ref11">11</xref>] . For both taxonomic and epidemiological studies of the genus Proteus, several phenotypic typing methods such as serology and phage typing have been used in the past for identification of Proteus species. In recent years, molecular typing methods were implemented for investigation of Proteus species. Sequencing of 16S rRNA gene [<xref ref-type="bibr" rid="scirp.58301-ref12">12</xref>] has been used. However, divergence was not suitable to detect some of Proteus species among clinical isolates. Sequence analysis of the RNA polymerase β subunit encoding gene (rpoB) has been proposed as a useful tool for bacterial identification [<xref ref-type="bibr" rid="scirp.58301-ref13">13</xref>] . In this study, rpoB sequencing is examined as a tool for intra-species discrimination of Proteus mirabilis clinical isolates.</p></sec><sec id="s2"><title>2. Materials and Methods</title><sec id="s2_1"><title>2.1. Bacterial Strains</title><p>Bacterial strains: A total of 20 bacterial isolates were obtained from Mansoura Hospitals in Egypt including 15 new isolate: (5) wound, (1) oral swab, (1) sputum, (4) stool, (2) Endo-tracheal and (2) urine and (5) seven years old Urine samples (<xref ref-type="table" rid="table1">Table 1</xref>).</p><table-wrap id="table1" ><label><xref ref-type="table" rid="table1">Table 1</xref></label><caption><title> Different Proteus mirabilis isolates, and their rpoB gene accession numbers, age and source of isolation</title></caption><table><tbody><thead><tr><th align="center" valign="middle" >Strain number</th><th align="center" valign="middle" >Source</th><th align="center" valign="middle" >GenBank number</th><th align="center" valign="middle" >Age</th></tr></thead><tr><td align="center" valign="middle" >2</td><td align="center" valign="middle" >Wound</td><td align="center" valign="middle" >(KR083867)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >7</td><td align="center" valign="middle" >Wound</td><td align="center" valign="middle" >(KR083868)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >8</td><td align="center" valign="middle" >Wound</td><td align="center" valign="middle" >(KR083869)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >9</td><td align="center" valign="middle" >Wound</td><td align="center" valign="middle" >(KR083870)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >12</td><td align="center" valign="middle" >Oral swab</td><td align="center" valign="middle" >(KR083871)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >14</td><td align="center" valign="middle" >Sputum</td><td align="center" valign="middle" >(KR083872)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >15</td><td align="center" valign="middle" >Endo-tracheal tube</td><td align="center" valign="middle" >(KR083873)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >48</td><td align="center" valign="middle" >Stool</td><td align="center" valign="middle" >(KR083874)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >54</td><td align="center" valign="middle" >Stool</td><td align="center" valign="middle" >(KR083875)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >58</td><td align="center" valign="middle" >Stool</td><td align="center" valign="middle" >(KR083876)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >78</td><td align="center" valign="middle" >Urine</td><td align="center" valign="middle" >(KR083877)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >55</td><td align="center" valign="middle" >Stool</td><td align="center" valign="middle" >(KR083883)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >11</td><td align="center" valign="middle" >Endo-tracheal aspirate</td><td align="center" valign="middle" >(KR083884)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >33</td><td align="center" valign="middle" >Urine</td><td align="center" valign="middle" >(KR083886)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >19</td><td align="center" valign="middle" >Wound</td><td align="center" valign="middle" >(KR083885)</td><td align="center" valign="middle" >New</td></tr><tr><td align="center" valign="middle" >303</td><td align="center" valign="middle" >Urine</td><td align="center" valign="middle" >(KR083878)</td><td align="center" valign="middle" >Old</td></tr><tr><td align="center" valign="middle" >313</td><td align="center" valign="middle" >Urine</td><td align="center" valign="middle" >(KR083879)</td><td align="center" valign="middle" >Old</td></tr><tr><td align="center" valign="middle" >302</td><td align="center" valign="middle" >Urine</td><td align="center" valign="middle" >(KR083880)</td><td align="center" valign="middle" >Old</td></tr><tr><td align="center" valign="middle" >305</td><td align="center" valign="middle" >Urine</td><td align="center" valign="middle" >(KR083881)</td><td align="center" valign="middle" >Old</td></tr><tr><td align="center" valign="middle" >346</td><td align="center" valign="middle" >Urine</td><td align="center" valign="middle" >(KR083882)</td><td align="center" valign="middle" >Old</td></tr></tbody></table></table-wrap></sec><sec id="s2_2"><title>2.2. Molecular Identification of Proteus Isolates</title><sec id="s2_2_1"><title>2.2.1. Amplification of rpoB Gene</title><p>Verification of the genus and species was confirmed by the molecular identification which was carried out by polymerase chain reaction (PCR) amplification of rpoB gene. Proteus isolates were grown on nutrient agar at 37˚C for overnight then the colonies were suspended in 300 μl of distilled water and boiled for 10 min. The supernatant was transferred into a new tube and used as DNA template.</p><p>A portion of the coding region of the rpoB gene was amplified with primers CM7 (59-AACCAGTTCCGC- GTTGGCCTGG-39) and CM31b (59-CCTGAACAACACGCTCGGA-39), according to the technique described by Mollet et al. (1997). The PCR amplicons generated were sequenced with primers CM81 (59-CAG- TTCCGCGTTGGCCTG-39) and CM31b (seq) (59-TGAACAACACGCTCGG-39) (Mollet et al., 1997) to obtain partial rpoB gene sequences. A reaction mixture containing 0.5 μM of each primer, 1.5 mM MgCl<sub>2</sub>, 0.2 mM dNTPs, 1 U Taq polymerase (Thermoscientific Dream Taq Green DNA polymerase ), 5 μl of template DNA and nuclease free water was added for a total volume of 25 μl per reaction. The PCR was performed under the following conditions: 2 min. initial denaturation at 94˚C, 35 cycles of denaturation (45 s at 94˚C), annealing (60 s at 55˚C), and extension (60 s at 72˚C); a final extension at 72˚C for 10 min. Finally, PCR product was analyzed by electrophoresis through 1% agarose gel and then visualized under UV light by staining with ethidium bromide.</p></sec><sec id="s2_2_2"><title>2.2.2. Determination of the Gene Sequence of rpoB Gene</title><p>Amplified rpoB gene fragments were purified from 20 strains using the PCR Purification Kit (MEGA quick- spin fragment DNA purification INTRON biotechnology, Sangdaewon-dong, Korea) for subsequent Sequencing. Purified PCR products were used as a template in sequencing reactions carried out with the ABI PRISM<sup>&#174;</sup> BigDye Terminator Cycle Sequencing Ready Reaction Kit (Applied Bio-systems, Foster City, USA). The reac- tion mixtures were analysed on an ABI 3730 DNA analyzer (Applied Bio-systems, Foster City, USA). Am- plicons were sequenced on both strands and predicted peptide sequences analyzed by the online BLAST of the NCBI website software (http://www.ncbi.nlm.nih.gov/BLAST/).</p><p>Sequence alignment and phylogenetic analysis was carried out on 909 bp of rpoB gene fragments using the CLUSTAL W algorithm (Thompson et al., 1994). To ensure the stability and reliability of phylogenetic relation- ships among strains used in this study, phylogenetic trees were reconstructed by using the Neighbour-joining and Maximum-parsimony methods in MEGA 4.1 package.</p><p>Sequences of this study were deposited under the following accession numbers (<xref ref-type="table" rid="table1">Table 1</xref>): KR083867, KR083868, KR083869, KR083870, KR083871, KR083872, KR083873, KR083874, KR083875, KR083876, KR083877, KR083878, KR083879, KR083880, KR083881, KR083882, KR083883, KR083884, KR083885, and KR083886.</p></sec></sec></sec><sec id="s3"><title>3. Results</title>rpoB Sequence Analysis for Proteus Species Identification<p>The phylogenetic tree is derived from partial (909 bp) rpoB gene sequences of clinical strains of Proteus mirabilis (<xref ref-type="fig" rid="fig1">Figure 1</xref>). By analyzing partial rpoB DNA sequences, a phylogenetic tree was derived from rpoB sequencing results with &gt;1000 bootstrap values. As a result, six rpoB groups could be described. All strains of our study were almost grouped in three respective branches more closely related to Proteus mirabilis reference strains installed from the GenBank. One branch (group 1) included the following 13 new strains: 14, 2, 12, 8, 55, 9, 15, 5, 7, 48, 11, 19 and 54 in addition to 346 and 305 showing similarity to Proteus mirabilis (ATCC 29906) strain. The other branch (group 2) differs from the first branch with a divergence of 0.22% including three old strains: 313, 302 and 303 in addition to the new isolate 78. Last branch (group 3) contains only a single newly isolated strain 33. The sequence of this strain shows differences in the rpoB 909 bp region analysed from the members of branch one and the second branch by 1.65% and 1.87% respectively. Strains of group 1 differs from P. penneri, P. vulgaris (MTCC 7306), P. vulgaris (DQ836268), P. vulgaris (ATCC 29906) and P. hauseri with a divergence 6.4%, 6.38%, 6.6%, 7% and 6.7% respectively. Strains of group 2 differs from P. penneri, P. vulgaris (ATCC 29906), P. vulgaris (DQ836268), P. vulgaris (MTCC 7306) and P. hauseri with a divergence 6.6%, 7.2%, 6.7%, 6.5% and 6.7% respectively. P. mirabilis strains of group 3 showed 5.72% and 6.27% nucleotide</p><fig id="fig1"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref></label><caption><title> Phylogenetic analysis of partial nucleotide sequences of the rpoB gene of reference and clinical strains of the genera Proteus. The tree was generated using the Neighbour-joining method</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/8-2270573x5.png"/></fig><p>differences compared to P. penneri and P. hauseri strains. This group differs by 5.61%, 6.05%, 6.49% from P. vulgaris (MTCC), P. vulgaris (DQ836268) and P. vulgaris (ATCC 29906).</p></sec><sec id="s4"><title>4. Discussion</title><p>The conventional typing methods are based on the presence of specific bacterial surface structures, which may change during the course of chronic infection [<xref ref-type="bibr" rid="scirp.58301-ref14">14</xref>] . Conventional typing methods, if applied alone, may sometimes lead to miss-classification of Proteus strains from different clinical source.</p><p>Identifying different types of organisms within a species is called typing. Traditional typing systems based on phenotype, such as anti-biogram, biotype, serotype and phage-type have been used for many years. Genotyping is mainly used to link the epidemiologically related isolates collected during an outbreak of nosocomial disease to one another. In other cases, genetic events (mutation, plasmid acquisition, etc.) may occur during the outbreak, so it may not be enough to know if strains are identical or not but rather may be necessary to know how related (or not) are the isolates [<xref ref-type="bibr" rid="scirp.58301-ref15">15</xref>] . In addition, 16S rRNA gene sequenceing followed by phylogenetic analysis of members of the family Enterobacteriaceae is associated usually with taxonomic problems which cannot be easily resolved because of the high degree of conservation in closely related species [<xref ref-type="bibr" rid="scirp.58301-ref16">16</xref>] . As an example, P. penneri and P. vulgaris could not be easily differentiated by this method [<xref ref-type="bibr" rid="scirp.58301-ref17">17</xref>] .</p><p>For this reason, the rpoB gene, encoding the RNA polymerase β-subunit, a highly conserved housekeeping gene is now used as a tool for molecular identification. Partial rpoB gene sequencing and analysis was implemented to provide more sensitivity [<xref ref-type="bibr" rid="scirp.58301-ref13">13</xref>] . In addition, it was previously reported that upon comparison of rpoB and 16S rRNA sequences more than 2.5% nucleotide divergence sequencing data of genera Proteus, Morganella and Providencia could be produced allowing the definition of rpoB clades [<xref ref-type="bibr" rid="scirp.58301-ref18">18</xref>] . This method was used to test the divergence of 14 clinical strains of species of the family Enterobacteriaceae, including type strains of P. mirabilis [<xref ref-type="bibr" rid="scirp.58301-ref13">13</xref>] . In the same manner, rpoB gene sequence was used to test the intra-species discrimination of rpoB sequences of the genus Proteus [<xref ref-type="bibr" rid="scirp.58301-ref19">19</xref>] .</p><p>Our 20 Proteus mirabilis strains isolated in this study were almost grouped in three respective branches. One branch (group 1) included the following new strains: 14, 2, 12, 8, 55, 9, 15, 5, 7, 48, 11, 19 and 54 in addition to 346. The other branch (group 2) differs from the first branch with a divergence of 0.22% including three old strains: 313, 302 and 303 in addition to 78. Last branch (group 3) contains only a single strain 33. The sequence of this strain shows differences in the rpoB 909 bp region analysed from the members of branch one and the second branch by 1.65% and 1.87% respectively. This is in contrast to another study [<xref ref-type="bibr" rid="scirp.58301-ref19">19</xref>] , as Proteus mirabilis strains were grouped into one designated group. However, in the same study [<xref ref-type="bibr" rid="scirp.58301-ref19">19</xref>] , two groups of P. vulgaris sequences could be described, one of them including the new strain type, differing from each other by 3.3% - 3.6% of their nucleotides and for both of these there was a nucleotide difference of 6.5% - 6.8% from the standalone former P. vulgaris strain type. These results provide further evidence for the existence of genetic differences within P. vulgaris rpoB sequences.</p><p>Moreover, in a previous study [<xref ref-type="bibr" rid="scirp.58301-ref20">20</xref>] , strain types of four species of the genus Proteus showed remarkably different rRNA gene restriction patterns after digestion with EcoRV and HincII 17. As a result, different ribogroups could be defined depending on the number and size of the bands observed among clinical strains. Strains of P. mirabilis had identical profiles to those of their respective type strains. Neither old nor new strains have their own discriminatory group. However, in strains belonging to other species such as P. vulgaris, distinct ribogroups could be defined, as these strains showed a considerable pattern did not sufficiently perform variability.</p></sec><sec id="s5"><title>5. Conclusions</title><p>In conclusion, rpoB sequencing proved able to characterize the different species of the genus Proteus on a molecular basis. However, our results provide further evidence for the existence of genetic differences within P. mirabilis. These findings indicate that rpoB sequencing method is not quite sufficient for fine typing and epidemiological purposes.</p><p>It appears that other new typing methods using another housekeeping gene must be further tried.</p></sec><sec id="s6"><title>Cite this paper</title><p>Mohamed Mohamed AdelEl-Sokkary, (2015) Genotyping of New and Old Proteus mirabilis Isolates from Mansoura Hospitals in Egypt by rpoB Sequence Analysis. Advances in Microbiology,05,549-554. doi: 10.4236/aim.2015.57057</p></sec></body><back><ref-list><title>References</title><ref id="scirp.58301-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">O’Hara, C.M., Brenner, F.W. and Miller, J.M. (2000) Classification, Identification, and Clinical Significance of Proteus, Providencia, and Morganella. Clinical Microbiology Reviews, 13, 534-546.  
http://dx.doi.org/10.1128/CMR.13.4.534-546.2000</mixed-citation></ref><ref id="scirp.58301-ref2"><label>2</label><mixed-citation publication-type="other" xlink:type="simple">Rather, P.N. (2005) Swarmer Cell Differentiation in Proteus mirabilis. Environmental Microbiology, 7, 1065-1073. 
http://dx.doi.org/10.1111/j.1462-2920.2005.00806.x</mixed-citation></ref><ref id="scirp.58301-ref3"><label>3</label><mixed-citation publication-type="other" xlink:type="simple">Rózalski, A., Sidorczyk, Z. and Kotelko, K. (1997) Potential Virulence Factors of Proteus bacilli. Microbiology and Molecular Biology Reviews, 61, 65-89.</mixed-citation></ref><ref id="scirp.58301-ref4"><label>4</label><mixed-citation publication-type="other" xlink:type="simple">Mobley, H.L. and Belas, R. (1995) Swarming and Pathogenicity of Proteus mirabilis in the Urinary Tract. Trends in Microbiology, 3, 280-284. http://dx.doi.org/10.1016/S0966-842X(00)88945-3</mixed-citation></ref><ref id="scirp.58301-ref5"><label>5</label><mixed-citation publication-type="other" xlink:type="simple">Luzzaro, F., Vigano, E.F., Fossati, D., Grossi, A., Sala, A., Sturla, C., Saudelli, M. and Toniolo, A. (2002) Prevalence and Drug Susceptibility of Pathogens Causing Bloodstream Infections in Northern Italy: A Two-Year Study in 16 Hospitals. European Journal of Clinical Microbiology and Infectious Diseases, 21, 849-855.</mixed-citation></ref><ref id="scirp.58301-ref6"><label>6</label><mixed-citation publication-type="other" xlink:type="simple">Daza, R., Gutierrez, J. and Piedrola, G. (2001) Antibiotic Susceptibility of Bacterial Strains Isolated from Patients with Community-Acquired Urinary Tract Infections. International Journal of Antimicrobial Agents, 18, 211-215. 
http://dx.doi.org/10.1016/S0924-8579(01)00389-2</mixed-citation></ref><ref id="scirp.58301-ref7"><label>7</label><mixed-citation publication-type="other" xlink:type="simple">Grahnquist, L., Lundberg, B. and Tullus, K. (1992) Neonatal Proteus meningoencephalitis. Case Report. Acta Pathologica, Microbiologica, et Immunologica Scandinavica, 100, 734-736.  
http://dx.doi.org/10.1111/j.1699-0463.1992.tb03992.x</mixed-citation></ref><ref id="scirp.58301-ref8"><label>8</label><mixed-citation publication-type="other" xlink:type="simple">Watanakunakorn, C. and Pernis, S.C. (1994) Protues mirabilis Bacteremia: A Review of 176 Cases during 1980-1992. Scandinavian Journal of Infectious Diseases. Supplementum, 26, 361-367.  
http://dx.doi.org/10.3109/00365549409008605</mixed-citation></ref><ref id="scirp.58301-ref9"><label>9</label><mixed-citation publication-type="other" xlink:type="simple">Isenstein, D. and Honig, E. (1990) Proteus vulgaris Empyema and Increased Pleural Fluid pH. Chest, 97, 511. 
http://dx.doi.org/10.1378/chest.97.2.511b</mixed-citation></ref><ref id="scirp.58301-ref10"><label>10</label><mixed-citation publication-type="other" xlink:type="simple">de Champs, C., Bonnet, R., Sirot, D., Chanal, C. and Sirot, J. (2000) Clinical Relevance of Proteus mirabilis in Hospital Patients: A Two Year Survey. The Journal of Antimicrobial Chemotherapy, 45, 537-539. 
http://dx.doi.org/10.1093/jac/45.4.537</mixed-citation></ref><ref id="scirp.58301-ref11"><label>11</label><mixed-citation publication-type="other" xlink:type="simple">Chen, C.Y., Chen, Y.H., Lu, P.L., Lin, W.R., Chen, T.C. and Lin, C.Y. (2012) Proteus mirabilis Urinary Tract Infection and Bacteremia: Risk Factors, Clinical Presentation, and Outcomes. Journal of Microbiology, Immunology and Infection, 45, 228-236. http://dx.doi.org/10.1016/j.jmii.2011.11.007</mixed-citation></ref><ref id="scirp.58301-ref12"><label>12</label><mixed-citation publication-type="other" xlink:type="simple">Woese, C.R., Kandler, O. and Wheelis, M.L. (1990) Towards a Natural System of Organisms: Proposal for the Domains Archaea, Bacteria, and Eucarya. Proceedings of the National Academy of Sciences of the United States of America, 87, 4576-4579. http://dx.doi.org/10.1073/pnas.87.12.4576</mixed-citation></ref><ref id="scirp.58301-ref13"><label>13</label><mixed-citation publication-type="other" xlink:type="simple">Mollet, C., Drancourt, M. and Raoult, D. (1997) rpoB Sequence Analysis as a Novel Basis for Bacterial Identification. Molecular Microbiology, 26, 1005-1011. http://dx.doi.org/10.1046/j.1365-2958.1997.6382009.x</mixed-citation></ref><ref id="scirp.58301-ref14"><label>14</label><mixed-citation publication-type="other" xlink:type="simple">Ojeniyi, B. (1988) Bacteriophages in Sputum of Cystic Fibrosis Patients as a Possible Cause of in Vivo Changes in Serotypes of Pseudomonas aeruginosa. Acta Pathologica, Microbiologica, et Immunologica Scandinavica, 96, 294-298. 
http://dx.doi.org/10.1111/j.1699-0463.1988.tb05305.x</mixed-citation></ref><ref id="scirp.58301-ref15"><label>15</label><mixed-citation publication-type="other" xlink:type="simple">Singh, A., Goering, R.V., Simjee, S., Foley, S.L. and Zervos, M.J. (2006) Application of Molecular Techniques to the Study of Hospital Infection. Clinical Microbiology Reviews, 19, 512-530. http://dx.doi.org/10.1128/CMR.00025-05</mixed-citation></ref><ref id="scirp.58301-ref16"><label>16</label><mixed-citation publication-type="other" xlink:type="simple">Sproer, C., Mendrock, U., Swiderski, J., Lang, E. and Stackebrandt, E. (1999) The Phylogenetic Position of Serratia, Buttiauxella and Some Other Genera of the Family Enterobacteriaceae. International Journal of Systematic Bacteriology, 49, 1433-1438. http://dx.doi.org/10.1099/00207713-49-4-1433</mixed-citation></ref><ref id="scirp.58301-ref17"><label>17</label><mixed-citation publication-type="other" xlink:type="simple">Cao, B., Wang, M., Liu, L., Zhou, Z., Wen, S., Rozalski, A. and Wang, L. (2009) 16S-23S rDNA Internal Transcribed Spacer Regions in Four Proteus Species. Journal of Microbiological Methods, 77, 109-118. 
http://dx.doi.org/10.1016/j.mimet.2009.01.024</mixed-citation></ref><ref id="scirp.58301-ref18"><label>18</label><mixed-citation publication-type="other" xlink:type="simple">Giammanco, G.M., Grimont, P.A., Grimont, F., Lefevre, M., Giammanco, G. and Pignato, S. (2011) Phylogenetic Analysis of the Genera Proteus, Morganella and Providencia by Comparison of rpoB Gene Sequences of Type and Clinical Strains Suggests the Reclassification of Proteus myxofaciens in a New Genus, Cosenzaea gen. nov., as Cosenzaea myxofaciens comb. nov. International Journal of Systematic and Evolutionary Microbiology, 61, 1638-1644. 
http://dx.doi.org/10.1099/ijs.0.021964-0</mixed-citation></ref><ref id="scirp.58301-ref19"><label>19</label><mixed-citation publication-type="other" xlink:type="simple">Giammanco, G., Pignato, S., Grimont, P.A.D., Grimont, F. and Giammanco, G.M. Genotyping of the Genus Proteus by rpoB Sequence Analysis. Italian Journal of Public Health, 19-22.</mixed-citation></ref><ref id="scirp.58301-ref20"><label>20</label><mixed-citation publication-type="other" xlink:type="simple">Pignato, S., Giammanco, G.M., Grimont, F., Grimont, P.A. and Giammanco, G. (1999) Molecular Characterization of the Genera Proteus, Morganella, and Providencia by Ribotyping. Journal of Clinical Microbiology, 37, 2840-2847.</mixed-citation></ref></ref-list></back></article>