Abstract
Background:
Proteus mirabilis (PM) as well as other membersof the Enterobacteriaceae family are a leading cause ofinfectious diseases in both the community and acute caresettings. The prevalence of multi-drug resistant (MDR) bacterialisolates have increased in the last few years, affectingthe prognosis and survival of hospitalized patients. The aimof our study was to determine the risk factors and clinicaloutcomes of urinary tract infections (UTIs) caused by MDR PMin patients hospitalized in our institution.
Methods:
This was a retrospective matched case-controlstudy. Records of patients with PM-positive urine culturewere reviewed, and data were included for analysis.
Results:
Univariate analysis revealed that the variablessignificantly associated with acquisition of MDR PM vs non-MDR PM UTI were younger age ([in years] median 77.5,range 20–94 vs median 78, range 40–94, p = 0.04), otherconcomitant infectious diseases (57.1 vs 35.7%, p = 0.037),number of prior infectious diseases (mean 0.95 ± 0.99 vs0.57 ± 0.85, p = 0.035), diagnosis of infection at hospitaladmission (67.9 vs 42.9%, p = 0.008), and prior therapywith antipseudomonal penicillin (17.9 vs 1.8%, p = 0.004),respectively. Mean length of hospitalization was 29.95 daysfor the MDR group and 30.04 days for the non-MDR group(p = non-significant [NS]). The crude mortality rate followinghospital admission was 19/56 (33.9%) vs 14 (25%)in the MDR PM and non-MDR PM groups, respectively(p = 0.300, odds ratio [OR] 1.54, 95% confidence interval[CI] 0.63–3.82). The production of extended-spectrum betalactamases(ESBL) was found in 100% of MDR-PM vs 31.5%of non-MDR-PM urine isolates (p < 0.001). All variablesfound to be significantly associated with MDR-PM UTI wereincluded in a logistic regression model. Independent riskfactors for MDR-PM UTI were empiric cephalosporin therapy(OR 4.694, 95% CI 1.76–12.516, p = 0.002) and prior antipseudomonalpenicillin (piperacillin/tazobactam) therapyduring the last year (OR 11.175, 95% CI 1.09–114.2,p = 0.04).
Conclusions:
Prior piperacillin/tazobactam and empiriccephalosporin use were the independent risk factors ofMDR-PM strains. All MDR-PM urinary isolates at our institutionwere ESBL producers. Therefore, carbapenem useremains the only available treatment option for MDR-PMisolates in our institution.
Similar content being viewed by others
References
National Nosocomial Infections Surveillance (NNIS): NNIS system report, data summary from January 1992 through June 2003. Issued August 2003. Am J Infect Control. 2003; 31: 481–498.
D’Agata EM: Rapidly rising prevalence of nosocomial multidrugresistant, gram-negative bacilli: a 9-year surveillance study. Infect Control Hosp Epidemiol 2004; 25: 842–846.
Karlowsky JA, Jones ME, Thornsberry C, Friedland IR, Sahm DF: Trends in antimicrobial susceptibilities among Enterobacteriaceae isolated from hospitalized patients in the United States from 1998 to 2001. Antimicrob Agents Chemother 2003; 47: 1672–1680.
Lockhart SR, Abramson MA, Beekmann SE, Gallagher G, Riedel S, Diekema DJ, Quinn JP, Doern GV: Antimicrobial resistance among Gram-negative bacilli causing infections in intensive are unit patients in the United States between 1993 and 2004. J Clin Microbiol 2007; 45: 3352–3359.
Giamarellos-Bourboulis EJ, Papadimitriou E, Galanakis N, Antonopoulou A, Tsaganos T, Kanellakopoulou K, Giamarellou H: Multidrug resistance to antimicrobials as a predominant factor influencing patient survival. Int J Antimicrob Agents 2006; 27: 476–481.
de Champs C, Bonnet R, Sirot D, Chanal C, Sirot J: Clinical relevance of Proteus mirabilis in hospital patients: a two year survey. J Antimicrob Chemother 2000; 45: 537–539.
Endimiani A, Luzzaro F, Brigante G, Perilli M, Lombardi G, Amicosante G, Rossolini GM, Toniolo A: Proteus mirabilis bloodstream infections: risk factors and treatment outcome related to the expression of extended-spectrum beta-lactamases. Antimicrob Agents Chemother 2005; 49: 2598–2605.
Luzzaro F, Perilli M, Amicosante G, Lombardi G, Belloni R, Zollo A, Bianchi C, Toniolo A: Properties of multidrug-resistant, ESBL-producing proteus mirabilis isolates and possible role of beta-lactam/beta-lactamase inhibitor combinations. Int J Antimicrob Agents 2001; 17: 131–135.
Chanal C, Bonnet R, De Champs C, Sirot D, Labia R, Sirot J: Prevalence of beta-lactamases among 1,072 clinical strains of proteus mirabilis: a 2-year survey in a French hospital. Antimicrob Agents Chemother 2000; 44: 1930–1935.
Hyle EP, Lipworth AD, Zaoutis TE, Nachamkin I, Fishman NO, Bilker WB, Mao X, Lautenbach E: Risk factors for increasing multidrug resistance among extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species. Clin Infect Dis. 2005; 40: 1317–1324.
Hernández JR, Martínez-Martínez L, Pascual A, Suárez AI, Perea EJ: Trends in the susceptibilities of proteus mirabilis isolates to quinolones. J Antimicrob Chemother 2000; 45: 407–408.
Saito R, Okugawa S, Kumita W, Sato K, Chida T, Okamura N, Moriya K, Koike K: Clinical epidemiology of ciprofloxacin-resistant Proteus mirabilis isolated from urine samples of hospitalised patients. Clin Microbiol Infect 2007; 13: 1204–1206.
Bauer AW, Kirby WM, Sherris JC, Turck M: Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966; 45: 493–496.
Gordon KA, Jones RN; SENTRY Participant Groups (Europe, Latin America, North America): Susceptibility patterns of orally administered antimicrobials among urinary tract infection pathogens from hospitalized patients in North America: comparison report to Europe and Latin America: results from the SENTRY Antimicrobial Surveillance Program (2000). Diagn Microbiol Infect Dis 2003; 45: 295–301.
Farrell DJ, Morrissey I, De Rubeis D, Robbins M, Felmingham D: A UK multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection. Infection 2003; 46: 94–100.
Johansen TE, Cek M, Naber KG, Stratchounski L, Svendsen MV, Tenke P, PEP and PEAP-study Investigators; Board of the European Society of Infections in Urology: Hospital acquired urinary tract infections in urology departments: pathogens, susceptibility and use of antibiotics. Data from the PEP and PEAP-studies. Int J Antimicrob Agents 2006; 28[Suppl 1]: S91–107.
Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC: A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982; 146: 719–723.
Byarugaba DK: A view on antimicrobial resistance in developing countries and responsible risk factors. Int J Antimicrob Agents 2004; 24: 105–110.
Paterson DL, Bonomo RA: Extended-spectrum β-Lactamases: a clinical update. Clin Microbiol Rev 2005; 18: 657–686.
Schwaber MJ, Navon-Venezia S, Schwartz D, Carmeli Y: High levels of antimicrobial coresistance among extended-spectrum-beta-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2005; 49: 2137–2139.
Samra Z, Ofir O, Lishtzinsky Y, Madar-Shapiro L, Bishara J: Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007; 30: 525–529.
Author information
Authors and Affiliations
Corresponding author
Additional information
This work has been submitted by K. Cohen-Nahum as part of the MDthesis to the Faculty of Health Sciences, Ben-Gurion University of theNegev, Beer-Sheva, Israel.
Rights and permissions
About this article
Cite this article
Cohen-Nahum, K., Saidel-Odes, L., Riesenberg, K. et al. Urinary Tract Infections Caused by Multi-Drug Resistant Proteus mirabilis: Risk Factors and Clinical Outcomes. Infection 38, 41–46 (2010). https://doi.org/10.1007/s15010-009-8460-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-009-8460-5