Proteus Mirabilis Infections
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uncomplicated UTIs) involves outpatient treatment
with either a 3-day course of
trimethoprim/sulfamethoxazole (TMP/SMZ) or an
oral fluoroquinolone (e.g., ciprofloxacin).[9][10][11]
An acute, uncomplicated pyelonephritis can be
treated on an outpatient basis with fluoroquinolones,
although a regimen of 7 to 14 days is recommended.
An alternative to this treatment is a one-time dose of
ceftriaxone or gentamycin followed by either
TMP/SMZ, an oral fluoroquinolone, or
cephalosporin for 7 to 14 days.
If a patient has a more severe condition or is in an
inpatient setting, they may begin antibiotic therapy
via intravenous administration of either ceftriaxone,
gentamycin, a fluoroquinolone, gentamycin plus
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ampicillin, or aztreonam until fever resolves. At this
point, they may switch to oral therapy with either
cephalosporin, an oral fluoroquinolone, or
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TMP/SMZ for up to 14 additional days.
If a patient presents with a complicated UTI (e.g., a
man or woman with a history of an underlying
condition that may increase the risk of failure of
therapy), they may also be treated in an outpatient
setting with oral antibiotics for 10 to 21 days as long
as they receive adequate follow-up.
Proteus infection can be avoided with proper
sanitation and hygiene, such as adequate sterilization
of medical equipment and surfaces. Additionally,
catheterization should be reserved for patients for
whom there is no other option.
Differential Diagnosis
Other Gram negative bacteria, such as E. coli or
Klebsiella species, may cause similar clinical
presentations with UTI and/or bacteremia. Bacterial
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culture is essential to identify the causative organism
of infection and target therapy appropriately.
Prognosis
The vast majority of proteus infections are associated
with the urinary tract. Most of the infections are
sensitive to the currently available antibiotics and the
outcomes are good in immunocompetent patients.
Complications
Symptoms generally resolve without complications
in immunocompetent patients. Immunocompromised
patients can be at higher risk for sepsis or prolonged
infections.
Deterrence and Patient Education
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Decreasing risk factors such as prolonged