Advertisement

Clinical manifestations and prognostic factors of Morganella morganii bacteremia

  • T.-Y. Lin
  • M.-C. Chan
  • Y.-S. Yang
  • Y. Lee
  • K.-M. Yeh
  • J.-C. Lin
  • F.-Y. Chang
Article

Abstract

Although Morganella morganii causes a variety of clinical infections, there are limited studies on M. morganii bacteremia after the year 2000. A total of 109 patients with M. morganii bacteremia at a medical center in Taiwan from 2003 to 2012 were studied. Among them, 30.3 % had polymicrobial bacteremia and 75.2 % had community-acquired infection. The most common underlying diseases were hypertension (62.4 %) and diabetes mellitus (38.5 %). The urinary tract (41.3 %) was the major portal of entry, followed by the hepatobiliary tract (27.5 %), skin and soft tissue (21.1 %), and primary bacteremia (10.1 %). Susceptibility testing of M. morganii isolates showed ubiquitous resistance to first-generation cephalosporins and ampicillin–clavulanate; resistance rates to gentamicin, piperacillin–tazobactam, and ciprofloxacin were 30.3 %, 1.8 %, and 10.1 %, respectively. Overall, the 14-day mortality was 14.7 %. Univariate analysis revealed that elevated blood urea nitrogen (BUN) values [p = 0.0137, odds ratio (OR) 5.26], intensive care unit (ICU) admission (p = 0.011, OR 4.4), and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (p < 0.001, OR 1.62) were significantly associated with mortality. The APACHE II score remained the only significant risk factor for mortality in multivariate analysis (p = 0.0012, OR 1.55). In conclusion, M. morganii bacteremia patients were mostly elderly, with one or more comorbidities. Most of the patients had community-acquired infection via the urinary and hepatobiliary tracts. Furthermore, prognosis can be predicted according to disease severity measured by the APACHE II score.

Keywords

Intensive Care Unit Admission Imipenem Piperacillin AmpC Tazobactam 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Abbott SL (2003) Enterobacteriaceae: introduction and identification. In: Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH (eds) Manual of clinical microbiology, 10th edn. American Society for Microbiology Press, Washington, pp 639–657Google Scholar
  2. 2.
    O’Hara CM, Brenner FW, Miller JM (2000) Classification, identification, and clinical significance of Proteus, Providencia, and Morganella. Clin Microbiol Rev 13:534–546CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Lee IK, Liu JW (2006) Clinical characteristics and risk factors for mortality in Morganella morganii bacteremia. J Microbiol Immunol Infect 39:328–334PubMedGoogle Scholar
  4. 4.
    Gautam V, Gupta V, Joshi RM, Sawhney G, Duhan S (2003) Morganella morganii-associated arthritis in a diabetic patient. J Clin Microbiol 41:3451CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Samonis G, Anatoliotaki M, Apostolakou H, Souglakos J, Georgoulias V (2001) Fatal septicemia and meningitis due to Morganella morganii in a patient with Hodgkin’s disease. Scand J Infect Dis 33:553–555CrossRefPubMedGoogle Scholar
  6. 6.
    Johnson JR, Feingold M (1998) Case of chorioamnionitis in an immunocompetent woman caused by Morganella morganii. J Matern Fetal Med 7:13–14CrossRefPubMedGoogle Scholar
  7. 7.
    Chang HY, Wang SM, Chiu NC, Chung HY, Wang HK (2011) Neonatal Morganella morganii sepsis: a case report and review of the literature. Pediatr Int 53(1):121–123CrossRefPubMedGoogle Scholar
  8. 8.
    Arranz-Caso JA, Cuadrado-Gomez LM, Romanik-Cabrera J, García-Tena J (1996) Pyomyositis caused by Morganella morganii in a patient with AIDS. Clin Infect Dis 22:372–373CrossRefPubMedGoogle Scholar
  9. 9.
    Chou YY, Chiu SK, Lai HC, Chang FY (2009) Tubo-ovarian abscess with Morganella morganii bacteremia. J Microbiol Immunol Infect 42(4):357–359PubMedGoogle Scholar
  10. 10.
    Farmer JJ III (2003) Enterobacteriaceae. In: Mandell GL, Bennett JE, Dolin R (eds) Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, 7th edn. Churchill Livingstone, New York, pp 438–449Google Scholar
  11. 11.
    National Committee for Clinical Laboratory Standards (NCCLS) (1999) Performance standards for antimicrobial susceptibility testing. 9th informational supplement. NCCLS document M100-S9. NCCLS, Wayne, PAGoogle Scholar
  12. 12.
    Kim BN, Kim NJ, Kim MN, Kim YS, Woo JH, Ryu J (2003) Bacteraemia due to tribe Proteeae: a review of 132 cases during a decade (1991–2000). Scand J Infect Dis 35:98–103CrossRefPubMedGoogle Scholar
  13. 13.
    Falagas ME, Kavvadia PK, Mantadakis E, Kofteridis DP, Bliziotis IA, Saloustros E, Maraki S, Samonis G (2006) Morganella morganii infections in a general tertiary hospital. Infection 34:315–321CrossRefPubMedGoogle Scholar
  14. 14.
    Williams EW, Hawkey PM, Penner JL, Senior BW, Barton LJ (1983) Serious nosocomial infection caused by Morganella morganii and Proteus mirabilis in a cardiac surgery unit. J Clin Microbiol 18:5–9PubMedCentralPubMedGoogle Scholar
  15. 15.
    Gebhart-Mueller Y, Mueller P, Nixon B (1998) Unusual case of postoperative infection caused by Morganella morganii. J Foot Ankle Surg 37:145–147CrossRefPubMedGoogle Scholar
  16. 16.
    Tessier F, Arpin C, Allery A, Quentin C (1998) Molecular characterization of a TEM-21 beta-lactamase in a clinical isolate of Morganella morganii. Antimicrob Agents Chemother 42:2125–2127PubMedCentralPubMedGoogle Scholar
  17. 17.
    Perilli M, Segatore B, de Massis MR, Riccio ML, Bianchi C, Zollo A, Rossolini GM, Amicosante G (2000) TEM-72, a new extended-spectrum beta-lactamase detected in Proteus mirabilis and Morganella morganii in Italy. Antimicrob Agents Chemother 44:2537–2539CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Miller GH, Sabatelli FJ, Hare RS, Glupczynski Y, Mackey P, Shlaes D, Shimizu K, Shaw KJ (1997) The most frequent aminoglycoside resistance mechanisms—changes with time and geographic area: a reflection of aminoglycoside usage patterns? Aminoglycoside Resistance Study Groups. Clin Infect Dis 24(Suppl 1):S46–S62CrossRefPubMedGoogle Scholar
  19. 19.
    Modakkas EM, Sanyal SC (1998) Imipenem resistance in aerobic gram-negative bacteria. J Chemother 10:97–101PubMedGoogle Scholar
  20. 20.
    Singla N, Kaistha N, Gulati N, Chander J (2010) Morganella morganii could be an important Intensive Care Unit pathogen. Indian J Crit Care Med 14:154–155CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • T.-Y. Lin
    • 1
  • M.-C. Chan
    • 2
  • Y.-S. Yang
    • 1
  • Y. Lee
    • 1
  • K.-M. Yeh
    • 1
  • J.-C. Lin
    • 1
  • F.-Y. Chang
    • 1
  1. 1.Division of Infectious Diseases and Tropical Medicine, Department of Internal MedicineTri-Service General Hospital, National Defense Medical CenterTaipeiTaiwan
  2. 2.Infection Control OfficeTri-Service General Hospital, National Defense Medical CenterTaipeiTaiwan

Personalised recommendations