Sections
Proteus Infections
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Sections Proteus Infections
- Overview
- Background
- Pathophysiology
- Epidemiology
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- Presentation
- History
- Physical
- Causes
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- DDx
- Workup
- Laboratory Studies
- Imaging Studies
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- Treatment
- Medical Care
- Surgical Care
- Consultations
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- Medication
- Medication Summary
- Antibiotics
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- Follow-up
- Further Inpatient Care
- Deterrence/Prevention
- Complications
- Prognosis
- Patient Education
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- References
Workup
Laboratory Studies
Proteus organisms are easily recovered through routine laboratory cultures. Most strains are lactose-negative and demonstrate characteristic swarming motility on agar plates. Any positive culture result from an otherwise sterile area should be considered an acute infection if clinical signs and symptoms are present.
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.
UTIs in symptomatic patients traditionally have been defined by recovering bacteria in large numbers (ie, >100,000 colony-forming units [CFUs]/mL) on examination. Bacterial counts of less than 100,000 CFUs/mL may indicate infection in urine samples, especially if obtained directly from the ureters or renal pelvis, whereas specimens from suprapubic catheters usually have bacterial counts greater than 100,000 CFUs/mL. However, even small numbers of organisms may be of true clinical significance in symptomatic patients (eg, women with the urethral syndrome).
Microscopic bacteriuria is best evaluated through uncentrifuged Gram staining of the urine. Microscopic bacteriuria is found in 90% of cases when bacterial counts exceed 100,000 CFUs/mL. Detection by microscopy confirms infection, but absence does not exclude infection. Pyuria is demonstrated in nearly all acute bacterial infections, but its absence calls the diagnosis into question. The leukocyte esterase dipstick test is a useful alternative to microscopic examination, but this method is less sensitive than microscopy.
Persistently alkaline urine with a positive Proteus culture finding should prompt an examination for renal calculi.
Although cultures are the most definitive way of confirming an acute Proteus infection, they often are prohibitively expensive and take time for complete identification. Cultures are most effective when patients do not respond to empiric therapy or when they have recurrent symptoms.
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Imaging Studies
Ultrasonography of the kidneys or a CT scan should be considered as part of a workup for Proteus infection of the urinary tract that does not resolve quickly with antimicrobial therapy. Calices and/or perinephric abscesses should be excluded. Given the increased severity of Proteus UTIs and the propensity of the organism to cause bacteremia in community-acquired infections and in patients with hydronephrosis or urolithiasis, radiographic studies such as renal ultrasonography or CT scanning should be considered in patients with severe UTIs, especially when complicated by bacteremia.
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References
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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].
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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.
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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.
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