A One Health Perspective on Proteus mirabilis: The Interaction of Virulence and Antimicrobial Resistance Across Human and Animal Reservoirs

Proteus mirabilis (P. mirabilis), a common commensal and opportunistic pathogen, circulates freely across interconnected human, animal, and environmental reservoirs, embodying the One Health concept. Its key virulence factors—urease activity, swarming motility, and biofilm formation—drive severe urinary tract infections, particularly catheter-associated ones. These virulence traits concurrently facilitate the acquisition and dissemination of antimicrobial resistance (AMR) via mobile genetic elements, leading to extensively drug-resistant clones. Epidemiological and genomic evidence confirms that identical multidrug-resistant clones and resistance mechanisms (ESBLs, carbapenemases) are shared among human clinical isolates, livestock, food products, and environmental samples. This demonstrates continuous, multi-directional transmission through interconnected zoonotic, foodborne, and environmental pathways. The synergistic convergence of potent virulence and escalating AMR within shared reservoirs heightens public health risks. Effective containment therefore demands integrated One Health strategies: enhanced cross-sectorial surveillance, stringent antimicrobial stewardship, robust infection control, and the creation of novel treatments. A coordinated global response is crucial to curb the spread of resistant P. mirabilis and preserve antibiotic efficacy.