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PMID: 15980325 Published · ppublish English Journal Article Research Support, Non-U.S. Gov't

Proteus mirabilis bloodstream infections: risk factors and treatment outcome related to the expression of extended-spectrum beta-lactamases.

Antimicrobial agents and chemotherapy ·Vol. 49 ·No. 7 ·2005-07-00 ·Pages 2598-605

Endimiani A, Luzzaro F, Brigante G, Perilli M, Lombardi G, Amicosante G, Rossolini GM, Toniolo A

Abstract

Bloodstream infection (BSI) due to Proteus mirabilis strains is a relatively uncommon clinical entity, and its significance has received little attention. This study was initiated to evaluate risk factors and treatment outcome of BSI episodes due to P. mirabilis producing extended-spectrum beta-lactamases (ESBLs). Twenty-five BSI episodes caused by P. mirabilis occurred at our hospital (Ospedale di Circolo e Fondazione Macchi, Varese, Italy) over a 7.5-year period. Phenotypic and molecular methods were used to assess ESBL production. Clinical records of BSI patients were examined retrospectively. Demographic data, underlying diseases (according to McCabe and Jackson classification and Charlson weighted index), risk factors, and treatment outcome were investigated by comparing cases due to ESBL-positive strains to cases due to ESBL-negative strains. Eleven isolates were found to express ESBLs (TEM-52 or TEM-92). The remaining 14 isolates were ESBL negative and were uniformly susceptible to extended-spectrum cephalosporins and monobactams. Comparison of the two groups showed that previous hospitalization in a nursing home (P = 0.04) and use of bladder catheter (P = 0.01) were significant risk factors for infections due to ESBL-positive strains. In addition, cases due to ESBL-positive strains showed a significantly higher mortality attributable to BSI (P = 0.04). BSI cases due to ESBL-negative isolates uniformly responded to therapy, whereas 5/11 cases due to ESBL-positive isolates failed to respond (P < 0.01). Use of carbapenems was associated with complete response independently of ESBL production. Therapeutic failure and mortality may occur in BSI episodes caused by ESBL-positive P. mirabilis isolates. Thus, recognition of ESBL-positive strains appears to be critical for the clinical management of patients with systemic P. mirabilis infections.

MeSH Terms
Aged Aged, 80 and over Anti-Bacterial Agents/pharmacology,therapeutic use Bacteremia/drug therapy,epidemiology,microbiology,mortality Drug Resistance, Bacterial Female Humans Male Microbial Sensitivity Tests Middle Aged Proteus Infections/drug therapy,epidemiology,microbiology,mortality Proteus mirabilis/drug effects,enzymology,pathogenicity Risk Factors Treatment Outcome beta-Lactamases/genetics,metabolism
Chemicals
Anti-Bacterial Agents beta-Lactamases
Authors & Affiliations
8 authors, click to expand affiliations / ORCID
Endimiani Andrea
Laboratorio di Microbiologia, Ospedale di Circolo e Università dell'Insubria, Viale Borri 57, 21100 Varese, Italy.
Luzzaro Francesco
Brigante Gioconda
Perilli Mariagrazia
Lombardi Gianluigi
Amicosante Gianfranco
Rossolini Gian Maria
Toniolo Antonio
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Article Info
Journal
Antimicrobial agents and chemotherapy
Abbr.
Antimicrob Agents Chemother
ISSN
0066-4804
DOI
10.1128/AAC.49.7.2598-2605.2005
Published
2005-07-00
Pages
2598-605
Language
English
Region
United States
NLM ID
0315061
PMCID
PMC1168714
Subset
IM
External Links
PubMed source DOI: 10.1128/AAC.49.7.2598-2605.2005 PMC Full Text View journal details
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