Sections
Proteus Infections
-
Sections Proteus Infections
- Overview
- Background
- Pathophysiology
- Epidemiology
- Show All
- Presentation
- History
- Physical
- Causes
- Show All
- DDx
- Workup
- Laboratory Studies
- Imaging Studies
- Show All
- Treatment
- Medical Care
- Surgical Care
- Consultations
- Show All
- Medication
- Medication Summary
- Antibiotics
- Show All
- Follow-up
- Further Inpatient Care
- Deterrence/Prevention
- Complications
- Prognosis
- Patient Education
- Show All
- References
Treatment
Medical Care
Cultures with susceptibility data are recommended, when available, to guide antimicrobial therapy. Most Proteus strains are susceptible to commonly used antibiotics, except nitrofurantoin and tetracycline. Like other members of Enterobacteriaceae, multidrug-resistant (MDR) strains of Proteus exist and are increasing in frequency; strains of P vulgarisgenerally are more resistant.
Recommended empiric treatment includes the following:
-
Uncomplicated UTIs in women can be treated on an outpatient basis with an oral quinolone for 3 days or trimethoprim/sulfamethoxazole (TMP/SMZ) for 3 days.
-
Acute uncomplicated pyelonephritis in women can be treated with oral quinolones for 7-14 days, single-dose ceftriaxone or gentamicin followed by TMP/SMZ, or an oral cephalosporin or quinolone for 14 days as outpatient therapy. For hospitalized patients, therapy consists of parenteral (or oral once the oral route is available) ceftriaxone, quinolone, gentamicin (plus ampicillin), or aztreonam until defervescence. Then, an oral quinolone, cephalosporin, or TMP/SMZ for 14 days may be added to complete treatment.
-
Complicated UTIs in men and women can be treated with a 10- to 21-day course of oral therapy (in the same manner as for hospitalized patients) as long as the follow-up is adequate.
Next:
Surgical Care
If struvite renal calculus is associated with Proteus infection, it must be removed to avert severe clinical outcomes and to avoid persistent sources that can lead to recurrent infection.
Most nonurologic infections result in abscesses. Radical surgical debridement is the cornerstone of successful therapy. Amputation may be necessary if skin or muscle necrosis of an extremity is the presenting infection, but tissue recovery is often better than expected. Broad-spectrum antimicrobial therapy is started empirically and is modified by the results of smears and cultures. Mortality and morbidity rates are high, even with adequate treatment.
Previous
Next:
Consultations
The discovery of stones requires an evaluation by a physician knowledgeable in the short- and long-term management of stones, typically a urologist or nephrologist.
Previous
Medication
References
Luzzaro F, Brigante G, D'Andrea MM, Pini B, Giani T, Mantengoli E, et al. Spread of multidrug-resistant Proteus mirabilis isolates producing an AmpC-type beta-lactamase: epidemiology and clinical management. Int J Antimicrob Agents. 2009 Apr. 33(4):328-33. [QxMD MEDLINE Link].
Lewis JS 2nd, Herrera M, Wickes B, Patterson JE, Jorgensen JH. First report of the emergence of CTX-M-type extended-spectrum beta-lactamases (ESBLs) as the predominant ESBL isolated in a U.S. health care system. Antimicrob Agents Chemother. 2007 Nov. 51(11):4015-21. [QxMD MEDLINE Link].
Wang JT, Chen PC, Chang SC, Shiau YR, Wang HY, Lai JF, et al. Antimicrobial susceptibilities of Proteus mirabilis: a longitudinal nationwide study from the Taiwan surveillance of antimicrobial resistance (TSAR) program. BMC Infect Dis. 2014 Sep 5. 14:486. [QxMD MEDLINE Link]. [Full Text].
Helmy MM, Wasfi R. Phenotypic and molecular characterization of plasmid mediated AmpC ß-lactamases among Escherichia coli, Klebsiella spp., and Proteus mirabilis isolated from urinary tract infections in Egyptian hospitals. Biomed Res Int. 2014. 2014:171548. [QxMD MEDLINE Link]. [Full Text].
Tsai HY, Chen YH, Tang HJ, Huang CC, Liao CH, Chu FY, et al. Carbapenems and piperacillin/tazobactam for the treatment of bacteremia caused by extended-spectrum ß-lactamase-producing Proteus mirabilis. Diagn Microbiol Infect Dis. 2014 Jul 26. [QxMD MEDLINE Link].
Williams GJ, Stickler DJ. Effect of triclosan on the formation of crystalline biofilms by mixed communities of urinary tract pathogens on urinary catheters. J Med Microbiol. 2008 Sep. 57:1135-40. [QxMD MEDLINE Link]. [Full Text].
Gaonkar TA, Caraos L, Modak S. Efficacy of a silicone urinary catheter impregnated with chlorhexidine and triclosan against colonization with Proteus mirabilis and other uropathogens. Infect Control Hosp Epidemiol. May 2007. 28:596-8. [QxMD MEDLINE Link].
Beck-Sague C, Villarino E, Giuliano D, et al. Infectious diseases and death among nursing home residents: results of surveillance in 13 nursing homes. Infect Control Hosp Epidemiol. 1994 Jul. 15(7):494-6. [QxMD MEDLINE Link].
Braunwald E, Fauci AS, Kasper DL. Harrison's Principles of Internal Medicine. 15th ed. New York, NY: McGraw Hill, Inc; 2001.
Dembry LM, Andriole VT. Renal and perirenal abscesses. Infect Dis Clin North Am. 1997 Sep. 11(3):663-80. [QxMD MEDLINE Link].
Endimiani A, Luzzaro F, Brigante G, et al. Proteus mirabilis bloodstream infections: risk factors and treatment outcome related to the expression of extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 2005 Jul. 49(7):2598-605. [QxMD MEDLINE Link].
Engel JD, Schaeffer AJ. Evaluation of and antimicrobial therapy for recurrent urinary tract infections in women. Urol Clin North Am. 1998 Nov. 25(4):685-701, x. [QxMD MEDLINE Link].
Kaye D, Tunkel AR, Fournier GR. Stein, ed. Internal Medicine. 5th ed. St Louis, Mo: Mosby-Year Book; 1998.
Li X, Lockatell CV, Johnson DE, et al. Development of an intranasal vaccine to prevent urinary tract infection by Proteus mirabilis. Infect Immun. 2004 Jan. 72(1):66-75. [QxMD MEDLINE Link].
Lipsky BA. Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment. Ann Intern Med. 1989 Jan 15. 110(2):138-50. [QxMD MEDLINE Link].
Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000.
Pewitt EB, Schaeffer AJ. Urinary tract infection in urology, including acute and chronic prostatitis. Infect Dis Clin North Am. 1997 Sep. 11(3):623-46. [QxMD MEDLINE Link].
Roberts JA. Management of pyelonephritis and upper urinary tract infections. Urol Clin North Am. 1999 Nov. 26(4):753-63. [QxMD MEDLINE Link].
Schwartz BF, Stoller ML. Nonsurgical management of infection-related renal calculi. Urol Clin North Am. 1999 Nov. 26(4):765-78, viii. [QxMD MEDLINE Link].
Walsh PC, Schaeffer AJ. Walsh PC, Schaeffer AJ, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1997.
Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am. 1997 Sep. 11(3):609-22. [QxMD MEDLINE Link].
Wu YL, Liu KS, Yin XT, Fei RM. GlpC gene is responsible for biofilm formation and defense against phagocytes and imparts tolerance to pH and organic solvents in Proteus vulgaris. Genet Mol Res. 2015 Sep 9. 14 (3):10619-29. [QxMD MEDLINE Link].
Pearson M, Rasko DA, Smith SN, Mobley HL. Transcriptome of swarming Proteus mirabilis. Infect Immun. June 2010. 78(6):2834-45. [QxMD MEDLINE Link].
See AlsoProteus vulgaris
Media Gallery
-
After 24 hours, this inoculated MacConkey agar culture plate cultivated colonial growth of gram-negative, rod-shaped, and facultatively anaerobic Proteus vulgaris bacteria. Courtesy of the CDC.
of 1
Tables
Back to List
Contributor Information and Disclosures
Author
Shirin A Mazumder, MD, FIDSA Associate Professor of Medicine, Director of Infectious Disease Fellowship Program, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, University of Tennessee Methodist Physicians
Shirin A Mazumder, MD, FIDSA is a member of the following medical societies: American Academy of HIV Medicine, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Memphis Medical Society, Society for Healthcare Epidemiology of America, Tennessee Medical Association
Disclosure: Nothing to disclose.
Specialty Editor Board
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Aaron E Glatt, MD, MACP, FIDSA, FSHEA Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, Mount Sinai South Nassau; Professor of Medicine, Icahn School of Medicine at Mount Sinai
Aaron E Glatt, MD, MACP, FIDSA, FSHEA is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.
Chief Editor
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Additional Contributors
Gus Gonzalez, MD Medical Oncologist, Cox Medical Center Branson and CoxHealth Springfield
Gus Gonzalez, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.
Acknowledgements
Rhett L Jackson, MD Associate Professor and Vice Chair for Education, Department of Medicine, Director, Internal Medicine Residency Program, University of Oklahoma College of Medicine; Assistant Chief, Medicine Service, Oklahoma City Veterans Affairs Hospital
Rhett L Jackson, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association
Disclosure: Nothing to disclose.
Kelley Struble, DO Fellow, Department of Infectious Diseases, University of Oklahoma College of Medicine
Kelley Struble, DO is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.
Close
What would you like to print?
What would you like to print?
- Print this section
- Print the entire contents of
- Print the entire contents of article
