Proteus Mirabilis Infections
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urine, dark urine, or hematuria. Patients also may
present with a fever which may be indicative of a
more severe condition, such as pyelonephritis,
bacteremia, or impending sepsis.
Prostatitis occurs more acutely in men than cystitis,
with the same set of symptoms, though may also be
accompanied by fever and chills. Prostatitis tends to
be more common with increased age. If there is
associated obstruction, patients also may complain of
perianal pain. A diffusely swollen and tender prostate
may be noted on palpation during a physical
examination.
Pyelonephritis occurs as a complication of either of
the conditions mentioned above, and the patient may,
therefore, complain of symptoms of urethritis or
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cystitis. Additional symptoms that are more
definitive of pyelonephritis include flank pain,
costovertebral angle tenderness, nausea and
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vomiting, fever, hematuria, and occasionally an
enlarged kidney felt on palpation.
Evaluation
The most definitive form of evaluation for an acute
P. mirabilis infection is a culture. Proteus species are
gram-negative, rod-shaped, and facultatively
anaerobic. The majority of strains are lactose
negative with a characteristic swarming motility that
will become evident on agar plates. One must always
correlate positive culture results with the clinical
presentation of the patient to form an accurate
diagnosis.
Additional evaluations include urine sample analysis
to evaluate for pyuria and leukocyte esterase. Pyuria
is generally present in the case of bacterial urinary
tract infection, such that lack of pyuria may indicate
an alternate cause of symptoms. Leukocyte esterase
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dipstick provides a good alternative to microscopy,
but is a less sensitive test than microscopic
examination. Gram staining of urine may help reveal
microscopic bacteriuria which would confirm
infection, although the absence of bacteriuria does
not exclude it.
A patient with a history of chronically alkaline urine
in combination with a positive Proteus culture should
be evaluated for renal stones (struvite stones).
If resolution is not seen with antibiotic therapy alone,
an ultrasound of the kidneys or a CT abdomen may
be warranted to rule out renal stones or a perinephric
abscess.
Treatment / Management
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Empirical treatment for an uncomplicated UTI
caused by P. mirabilis (much like other