Proteus mirabilis bloodstream infections: Risk factors and treatment outcome related to the expression of extended-spectrum β-lactamases

Andrea Endimiani, Francesco Luzzaro, Gioconda Brigante, Mariagrazia Perilli, Gianluigi Lombardi, Gianfranco Amicosante, Gian Maria Rossolini, Antonio Toniolo

Research output: Contribution to journalArticle

100 Citations (Scopus)

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 β-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.

Original languageEnglish
Pages (from-to)2598-2605
Number of pages8
JournalAntimicrobial Agents and Chemotherapy
Volume49
Issue number7
DOIs
Publication statusPublished - Jul 2005

Fingerprint

Proteus mirabilis
Infection
Proteus Infections
Monobactams
Carbapenems
Mortality
Cephalosporins
Nursing Homes
Italy
Urinary Bladder
Hospitalization
Catheters
Demography
Therapeutics

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Proteus mirabilis bloodstream infections : Risk factors and treatment outcome related to the expression of extended-spectrum β-lactamases. / Endimiani, Andrea; Luzzaro, Francesco; Brigante, Gioconda; Perilli, Mariagrazia; Lombardi, Gianluigi; Amicosante, Gianfranco; Rossolini, Gian Maria; Toniolo, Antonio.

In: Antimicrobial Agents and Chemotherapy, Vol. 49, No. 7, 07.2005, p. 2598-2605.

Research output: Contribution to journalArticle

Endimiani, A, Luzzaro, F, Brigante, G, Perilli, M, Lombardi, G, Amicosante, G, Rossolini, GM & Toniolo, A 2005, 'Proteus mirabilis bloodstream infections: Risk factors and treatment outcome related to the expression of extended-spectrum β-lactamases', Antimicrobial Agents and Chemotherapy, vol. 49, no. 7, pp. 2598-2605. https://doi.org/10.1128/AAC.49.7.2598-2605.2005
Endimiani, Andrea ; Luzzaro, Francesco ; Brigante, Gioconda ; Perilli, Mariagrazia ; Lombardi, Gianluigi ; Amicosante, Gianfranco ; Rossolini, Gian Maria ; Toniolo, Antonio. / Proteus mirabilis bloodstream infections : Risk factors and treatment outcome related to the expression of extended-spectrum β-lactamases. In: Antimicrobial Agents and Chemotherapy. 2005 ; Vol. 49, No. 7. pp. 2598-2605.
@article{19d9e6262ba0474c84635058a674297b,
title = "Proteus mirabilis bloodstream infections: Risk factors and treatment outcome related to the expression of extended-spectrum β-lactamases",
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 β-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.",
author = "Andrea Endimiani and Francesco Luzzaro and Gioconda Brigante and Mariagrazia Perilli and Gianluigi Lombardi and Gianfranco Amicosante and Rossolini, {Gian Maria} and Antonio Toniolo",
year = "2005",
month = "7",
doi = "10.1128/AAC.49.7.2598-2605.2005",
language = "English",
volume = "49",
pages = "2598--2605",
journal = "Antimicrobial Agents and Chemotherapy",
issn = "0066-4804",
publisher = "American Society for Microbiology",
number = "7",

}

TY - JOUR

T1 - Proteus mirabilis bloodstream infections

T2 - Risk factors and treatment outcome related to the expression of extended-spectrum β-lactamases

AU - Endimiani, Andrea

AU - Luzzaro, Francesco

AU - Brigante, Gioconda

AU - Perilli, Mariagrazia

AU - Lombardi, Gianluigi

AU - Amicosante, Gianfranco

AU - Rossolini, Gian Maria

AU - Toniolo, Antonio

PY - 2005/7

Y1 - 2005/7

N2 - 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 β-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.

AB - 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 β-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.

UR - http://www.scopus.com/inward/record.url?scp=21444453435&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=21444453435&partnerID=8YFLogxK

U2 - 10.1128/AAC.49.7.2598-2605.2005

DO - 10.1128/AAC.49.7.2598-2605.2005

M3 - Article

C2 - 15980325

AN - SCOPUS:21444453435

VL - 49

SP - 2598

EP - 2605

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

SN - 0066-4804

IS - 7

ER -