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The factor in sera of patients with cystic fibrosis (CF) and their parents which agglutinates Proteus vulgaris has characteristics similar to those of IgG antibody to this organism. Sera of patients without CF who have P. vulgaris infections agglutinate the organism similarly. At present there are too many false-positives in a control population for the test to be widely useful for heterozygote identification.
Three cases of Proteus mirabilis meningitis in neonates are reported, in 2 of which abscess formation was proved neuroradiologically. All neonates with P. mirabilis meningitis warrant a CAT scan, as does any newborn infant with meningitis who has a continuing pleocytosis after adequate treatment with antibiotics.
The properties and characteristics of 296 Proteus strains isolated from hospital patients and from sewage have been examined with a view to determining those characters which are of most use in following and detecting cross-infection.Ninety-six per cent of the organisms isolated were P. mirabilis and it was found that by identifying biotypes and by phage typing the species could be divided into a relatively large number of groups which would be useful for epidemiological investigation.
Measuring ethanol formed from arabinose by Escherichia coli and dimethyl disulphide formed from methionine by Proteus mirabilis is a rapid way of detecting these organisms in the urine. Ethanol and dimethyl disulphide are detected by head-space gas-liquid chromatography. Since sedimented organisms and not whole urine are used the method is not subject to interference from compounds within the urine. When it was tested on 122 samples of urine, 94 from patients with suspected urinary infection and 28 supposedly uninfected control specimens, the results correlated well with viable counts by a conventional bacteriological method. As well as being rapid (results available in four hours) the method is reliable, easy to use, and could be automated. It now requires extensive testing in a hospital laboratory.
The antigenic and immunogenic activities of fimbriae and flagella from three uropathogenic strains of Proteus mirabilis were compared. Flagella were obtained by mechanical treatment and fimbriae were isolated from cells by heat shock, ammonium sulfate precipitation, sodium deoxycholate and urea treatment, and gel filtration. Both preparations inoculated to mice demonstrated high antigenicity. Titers up to 1:80,000 were determined by an enzyme-linked immunosorbent assay either against the homologous or heterologous strains. When immunized mice were challenged with homologous or heterologous hematogenous infecting doses, a good cross protection was achieved only when fimbriae were used as antigens. Cross-reactivity found between the three fimbriae antisera, and the presence of common proteins in sodium dodecyl sulfate polyacrylamide gel electrophoresis patterns of fimbriae, should validate the study of these proteins to determine the existence of a shared adhesin.
Associations of penicillin, streptomycin, tetracycline and polymyxin B with rifampicin were tested for synergism against Pseudomonas and Proteus pathological strains. The combination of rifampicin and polymyxin B was clearly synergistic for all strains as it was evaluated by isobolograms and killing curvesmthe bactericidal action of this association, without any cross-resistance between its components, may eradicate gram-negative bacteria infections with marked polyvalent drug resistances.
Resistance patterns that are currently problematic in Europe can vary greatly within the same species over time, among various patient populations and among geographic regions on the same continent. The results from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program, which monitors carbapenem resistance rates in institutions using meropenem, were used to determine resistance differences among Proteus mirabilis. MIC results from 688 P. mirabilis strains were classified into 4 patient care groups: ICU (n=426), neutropenia patients (NP; n=145), general wards (n=97) and cystic fibrosis patients (CF; n=20). A total of 40 centers from 12 European countries have participated since 1997, divided into 3 geographic regions (East, North, South). All testing was performed by NCCLS reference methods and interpretive criteria, including screening of extended-spectrum beta-lactamase (ESBL) phenotypes. Over the monitored interval the resistance rates varied for each agent without a clear trend toward a greater rate. Rank order of susceptibility was: meropenem (99%) > piperacillin/tazobactam (TAZ; 96%) > cefepime (95%) > ceftazidime (CAZ; 94%) > imipenem (IPM; 92%). Ciprofloxacin (CIP) was the least active agent tested (MIC90 4 microg/ml; 86% susceptible). Unexpectedly, 3.6% of P. mirabilis were imipenem-resistant (MIC, > or = 16 microg/ml). Greater rates of resistance were found for strains from NP and CF patients, and from eastern or southern European sites, usually associated with epidemic clusters. Generally susceptible species such as P. mirabilis have recently emerged as therapeutic problems in European medical centers following mutations that compromise CIP, CAZ and aminoglycoside use. Imipenem also showed decreased susceptibility of greater than 7% compared to less than 1% for meropenem. Continued surveillance by the MYSTIC Program appears to be a prudent practice to focus effective empiric treatment regimens.
A problem encountered in patients undergoing long-term catheterization of the urinary tract is that of encrustation and blockage of the catheter by crystalline bacterial biofilms. This is principally caused by the action of the urease-producing pathogen Proteus mirabilis. A major aim of this work is to develop materials resistant to encrustation. Here, the effects of polymer surface properties on the adhesion of P. mirabilis are examined. Spin-coated polymer films were characterized through contact angle measurements to give the Lifschitz-van der Waals, electron acceptor and electron donor terms of the surface free energy, gamma(s)LW, gamma(s)+ and gamma(s)- respectively. A parallel-plate flow cell was used to assess adhesion to these polymer films of P. mirabilis suspended in an aqueous phosphate buffer, pH 7.4, ionic strength 0.26 mol/kg. P. mirabilis was found to adhere significantly less (p < 0.02) to films of agarose, poly(2-hydroxyethylmethacrylate) and cross-linked poly(vinyl alcohol) than to more hydrophobic materials. These polymer films were found to be strongly electron donating, i.e. possessing large gamma(s)-. Films examined using scanning electron microscopy mostly showed no evidence of roughness down to a scale of 1-10 microm. The better performance is thought to be due to a repulsive interaction with the bacterial surface caused by acid/base-type interactions.
The mortality patterns and the LD50/30 for mice free from Enterobacteriaceae, mice contaminated with Enterobacter cloacae, and mice inoculated with Escherichia coli, Klebsiella pneumoniae or Proteus vulgaris were examined after whole-body irradiation with gamma rays. no clear differences were observed among the infected groups, but there were clear differences between then and those negative for Enterobacteriaceae. The LD50/30 of Enterobacteriaceae-positive mice was similar to that for conventional mice. All 4 nonpathogenic Enterobacteriaceae had very similar detrimental effects on mice after lethal irradiation.
The protease ZapA, secreted by Proteus mirabilis, has been considered to be a virulence factor of this opportunistic bacterium. The control of its expression requires the use of an appropriate methodology, which until now has not been developed. The present study focused on the replacement of azocasein with fluorogenic substrates, and on the definition of enzyme specificity. Eight fluorogenic substrates were tested, and the peptide Abz-Ala-Phe-Arg-Ser-Ala-Ala-Gln-EDDnp was found to be the most convenient for use as an operational substrate for ZapA. A single peptide bond (Arg-Ser) was cleaved with a Km of 4.6 microM, a k cat of 1.73 s-1, and a catalytic efficiency of 376 (mM s)-1. Another good substrate for ZapA was peptide 6 (Abz-Arg-Pro-Pro-Gly-Phe-Ser-Pro-Phe-Arg-Gln-EDDnp) which was cleaved at a single bond (Phe-Ser) with a Km of 13.6 microM, a k cat of 3.96 s-1 and a catalytic efficiency of 291 (mM s)-1. The properties of the amino acids flanking the scissile bonds were also evaluated, and no clear requirement for the amino acid residue at P1 was found, although the enzyme seems to have a preference for a hydrophobic residue at P2.
Patients with Proteus mirabilis bacteremia at a large community teaching hospital during a 13-year period (1980-1992) were retrospectively reviewed. There were 176 patients whereof 44 (25%) had polymicrobial bacteremia. The median age of patients was 75 years and 64.2% were 70 years or older. Of the patients 56.8% came from a nursing home, 64.2% had an indwelling Foley catheter, and 20.5% nosocomial bacteremia. The most common source of bacteremia was the urinary tract (52.8%) whereas the lower respiratory tract was an uncommon source. Hypotension was present in 30.1% of patients. The overall mortality rate was 29.0% with an attributable mortality rate of 25.6%. The mortality rate of polymicrobial bacteremia (38.6%) was higher than that of monomicrobial bacteremia (25.8%). For patients with monomicrobial bacteremia, significant increase in mortality was found in patients who had nosocomial infection (p < 0.02), whose source of bacteremia was other than the urinary tract (p < 0.01), who had ultimately fatal underlying conditions (p < 0.01), who had hypotension (p < 0.001), who had increase in serum creatinine (p < 0.05), or who had increase in serum bilirubin (p < 0.05).
The serum antibody titers against Escherichia coli and/or Proteus mirabilis were elevated in 26 of 80 patients (33%) with a conduit urinary diversion. Urographic findings were abnormal in 44 of these 80 patients (55%). Urography was normal in 59% of the patients with normal antibody titers, but in only 15% of those with elevated titers. Raised antibody levels against E. coli O antigen (greater than 256 before and/or greater than 32 after mercaptoethanol treatment of serum) were associated with wide upper urinary tract or calculi more often than were normal E. coli antibody titers. Raised titers against P. mirabilis (greater than 256 before and/or greater than 32 after mercaptoethanol treatment of serum) were associated with scarring of the renal parenchyma more frequently than were normal titers. A statistically significant association was found between "small" kidney area and raised serum antibody titers against E. coli or P. mirabilis. The frequency of "small" kidney increased with the time lapse after urinary diversion. At 3 to 11 months postoperatively it was 29%, but among the patients with urinary diversion for more than five years the corresponding frequency was 82%. When at least one kidney was "small", the serum creatinine was higher than when both kidneys were of normal size. Patients with raised antibody titers tended also to have high serum creatinine (greater than or equal to 124 mumol/l) more often than those with normal titers (23 vs. 10%). These observations imply a connection between elevation of the antibody titers and destruction of the renal parenchyma in patients with conduit urinary diversion. They illustrate the value of antibody titration in the follow-up of patients with urinary diversion.
Elevated serum antibody titers against Escherichia coli and/or Proteus mirabilis were found in 35% of 89 patients with a conduit urinary diversion. Statistical analysis showed significant correlation between the titers and growth of E. coli or P. mirabilis in conduit urine. But 17 (24%) of 72 patients without E. coli in urine cultures had raised E. coli antibody titer. Only 3 (4%) of 68 patients without growth of P. mirabilis had raised P. mirabilis antibody titer. When the post-diversion observation period was more than five years, the frequency of antibody titer elevation was greater than in patients with shorter post-diversion follow-up. The volume of residual urine in the conduit showed statistically significant correlation with presence of bacteriuria and with the antibody titer level against P. mirabilis. Patients with high antibody titers tended to have high readings of serum creatinine. Antibiotic therapy reduced elevated E. coli and P. mirabilis antibody titers. Titration of antibodies to E. coli and P. mirabilis is recommended in the follow-up care of patients with conduit urinary diversion.
The authors report their experience treating a polymicrobial ventriculoperitoneal (VP) shunt infection in a developmentally delayed 21-year-old woman. Cerebrospinal fluid (CSF) cultures grew Serratia marcescens and Proteus mirabilis. On admission and throughout her hospitalization, results of physical examination of her abdomen were normal, and radiographic studies showed no evidence of bowel perforation or pseudocyst formation. Contrast-enhanced computed tomography of the abdomen revealed a small fluid collection. After a course of intravenous gentamicin and imipenem with cilastatin in conjunction with intrathecal gentamicin, the infection was resolved and the VP shunt was reimplanted. Although VP shunt infections are not uncommon, S. marcescens as a causative agent is exceedingly rare and potentially devastating. Only two previous cases of S. marcescens shunt infection have been reported in the literature. Authors reporting on S. marcescens infections in the central nervous system (CNS) have observed significant morbidity and death. Although more common, the presence of P. mirabilis in the CSF is still rare and highly suggestive of bowel perforation, which was absent in this patient. Spontaneous bacterial peritonitis was the likely source from which these bacteria gained entrance into the VP shunt system, eventually causing ventriculitis in this patient. The authors conclude that in light of the high morbidity associated with S. marcescens infection of the CNS, intrathecal administration of gentamicin should be strongly considered as part of first-line therapy for S. marcescens infections in VP shunts.
The recent development of multidrug-resistant strains of Proteus rettgeri prompted a 6-year review of infections with this organism. Ninety percent of infections involved the urinary tract. Fifty percent of infections occurred on the neurology ward, where a progressive annual increase in attack rate was noted. Statistically significant (P less than 0.005) increases in total length of hospitalization, length of hospitalization before infection, presence and duration of indwelling Foley catheterization, prior exposure to antibiotics, and the prevalence of paraplegia were present in P. rettgeri urinary tract infections as compared with a control group. A progressive increase in resistance to kanamycin, streptomycin, ampicillin, and gentamicin occurred during 6 years. Disc diffusion sensitivities of recent isolates show total resistance to commonly tested antibiotics. Eighty percent or more of strains are inhibited, however, by 3.13 mug/ml of amikacin and cefoxitin, and 0.4 mug/ml of ticarcillin.
BACKGROUND: Preseptal cellulitis is a serious ocular condition that--if left untreated--has the potential to cross the septal barrier, spread to the posterior orbit, and may result in fatal complications. Because it is difficult to determine the pathogen responsible for any cellulitis without aspirating a culture sample, treatment is usually instituted by an assumption of the most common causative organisms, Staphylococcus or Streptococcus. CASE REPORT: A 42-year-old black woman manifested signs and symptoms consistent with right preseptal cellulitis. Throughout treatment, visual acuity remained 20/20 for both eyes, extraocular muscles were unrestricted without pain, and anterior globe structures were clear. The patient was started on a regimen of 250-mg oral dicloxacillin four times a day. When no response was seen at 36 hours, the patient was changed to 500-mg oral ciprofloxacin every 12 hours. She responded to the 500-mg ciprofloxacin and recovered with no sequelae. An abscess, which had formed during the cellulitis, self expressed and this material was cultured. The cultures identified the responsible organism as Proteus species, an unexpected pathogen in a well-groomed patient. CONCLUSION: This case demonstrates the need to consider alternate pathogens when treating preseptal cellulitis, change medications accordingly, and consider alternate treatments as needed.
Proteus mirabilis strains (88 isolates) from hospitalised patients with urinary tract infection were tested for antibiotic susceptibility, ESBL production and their ability to produce proticin or on their susceptibility to proticin. Antibiotic susceptibility test was performed by standard disc diffusion method according to NCCLS. Proticin typing was made by the standard strain set from the B. W. Senior collection. Most (59%) strains belonged to ESBL producers and were more resistant to antibiotics than ESBL-negative strains. Predominant proticin patterns among the ESBL (+) strains were: P1,2(6)/SO (23%), P1,2/SO (13.5%). Among the ESBL-negative strains more frequent were P6/SO (16.6%), P1,2/SO (13.8%) and P3,6/SO (13.8%) proticin types.
Immunological studies in 95 children with uveitis associated with juvenile chronic arthritis revealed infection with Proteus mirabilis in 14.7% cases, mainly in cases with reactive arthritis and juvenile rheumatoid arthritis (JRA). A clear-cut relationship between P. mirabilis infection and severity of the disease was detected. In 85% children infected with P. mirabilis uveitis was associated with a rapid decrease of ocular functions and development of complications, one of the most frequent of which was vitreous fibrosis, generally not typical of classical rheumatoid uveitis. Antibodies to P. mirabilis were detected in 72.2% children with positive antinuclear factor, a marker of ophthalmoarticular rheumatic diseases. The pathogenetic significance of P. mirabilis in uveitis associated with articular involvement deserves further investigation, but even now the detection of P. mirabilis can be used as a marker of uveitis exacerbations and severity.