From the Guidelines
Proteus mirabilis urinary tract infections should be treated with antibiotics such as fluoroquinolones, trimethoprim-sulfamethoxazole, or third-generation cephalosporins, with consideration of carbapenems for complicated infections, as recommended by recent guidelines 1.
Treatment Options
- Fluoroquinolones (e.g., ciprofloxacin 500mg twice daily for 7-14 days)
- Trimethoprim-sulfamethoxazole (160/800mg twice daily for 7-14 days)
- Third-generation cephalosporins (e.g., ceftriaxone 1-2g daily)
- Carbapenems (e.g., meropenem 1g every 8 hours) for complicated infections
Risk Factors
- Urinary catheterization
- Urinary tract abnormalities
- Kidney stones
- Advanced age
- Immunosuppression
- Recent antibiotic use
- Healthcare facility exposure
Management Considerations
- Adequate hydration to promote frequent urination
- Complete antibiotic courses to prevent recurrence and resistance
- Addressing underlying anatomical issues, such as urinary tract abnormalities or kidney stones
- Considering imaging studies for recurrent infections to identify structural abnormalities or stones that could harbor bacteria, as suggested by the ACR Appropriateness Criteria 1
Complications
- Struvite stone formation due to the urease-producing ability of Proteus mirabilis, which raises urine pH and creates an alkaline environment
- Persistent infections, which can be particularly problematic in patients with underlying anatomical issues or immunosuppression 1
From the FDA Drug Label
URINARY TRACT INFECTIONS (complicated and uncomplicated) Caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae Urinary Tract Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris
The treatment options for urinary tract infections (UTIs) caused by Proteus mirabilis include:
- Ceftriaxone (2)
- Trimethoprim-sulfamethoxazole (3)
- Ciprofloxacin (4) The risk factors for UTIs caused by Proteus mirabilis are not explicitly stated in the provided drug labels. However, it can be inferred that individuals with compromised immune systems or those who have undergone surgical procedures may be at a higher risk of developing UTIs, including those caused by Proteus mirabilis.
From the Research
Risk Factors for Proteus mirabilis Causing UTI
- Proteus mirabilis is one of the most common causative agents of urinary tract infection (UTI), especially in young pregnant women 5
- The bacteria can cause complicated UTI, especially in catheterized patients 6
- Urease-mediated urea hydrolysis is responsible for both virulence of the organism and the ability to cause urolithiasis 7
- Long-term urinary catheterization can lead to colonization and swarming motility of Proteus mirabilis, making elimination difficult 8
Treatment Options for Proteus mirabilis UTI
- Antibiotic susceptibility testing is essential to determine the effective treatment option, as Proteus mirabilis can exhibit multiple antibiotic resistance 5, 6
- Ceftriaxone, norfloxacin, and gentamicin are some of the antibiotics that have shown susceptibility against Proteus mirabilis 6
- Antibiofilm-impregnated catheters can help prevent Proteus mirabilis colonization and swarming motility on indwelling urinary catheters 8
- Vaccination against Proteus mirabilis is being explored, with the MR/P fimbria being a promising vaccine candidate 7
Antibiotic Resistance in Proteus mirabilis
- Proteus mirabilis can acquire antibiotic resistance genes, including carbapenemase genes, making it a multidrug-resistant bacterium 9
- The emergence and spread of multidrug-resistant Proteus mirabilis isolates are being reported, making treatment challenging 9
- Plasmid-mediated multiple antibiotic resistance is common in Proteus mirabilis, making it essential to monitor antibiotic susceptibility patterns 5