What is the recommended treatment for Morganella morganii infections?

From the Guidelines

The recommended treatment for Morganella morganii infections is meropenem, as it has been shown to be effective in a case of complex prosthetic joint infection involving M. morganii, Enterococcus faecium, and Staphylococcus epidermidis 1. When treating M. morganii infections, it's essential to consider the potential for antibiotic resistance and the need for combination therapy in severe cases.

• Key considerations for treatment include:
  • Antibiotic selection: Meropenem is a carbapenem antibiotic that has been effective in treating M. morganii infections, as seen in the case study 1.
  • Dosage and administration: The dosage of meropenem can range from 500mg to 1g IV every 8 hours, depending on the severity of the infection and the patient's renal function.
  • Treatment duration: The treatment duration for M. morganii infections can vary from 7-14 days or longer, depending on the site and severity of the infection, as well as the patient's clinical response.
  • Combination therapy: In some cases, combination therapy with other antibiotics, such as ciprofloxacin or pristinamycin, may be necessary to ensure adequate coverage and prevent the development of resistance 1.
  • Surgical intervention: For abscesses or device-related infections, surgical drainage or removal of the infected foreign body may be required in addition to antibiotic therapy. It's crucial to obtain antibiotic susceptibility testing before initiating therapy, as M. morganii frequently shows resistance to multiple antibiotics, including ampicillin, amoxicillin, first and second-generation cephalosporins, and many aminoglycosides 1. Monitoring clinical response and adjusting therapy based on culture results and clinical improvement is essential, as M. morganii can develop resistance during treatment 1.

From the FDA Drug Label

Aerobic gram-negative microorganisms Morganella morganii Ciprofloxacin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section of the package insert for Ciprofloxacin Hydrochloride Tablets USP, 250mg, 500mg and 750mg. Adult Patients: 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 Skin and Skin Structure Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Proteus vulgaris, Providencia stuartii, Morganella morganii, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus, methicillin-susceptible Staphylococcus epidermidis, or Streptococcus pyogenes

The recommended treatment for Morganella morganii infections is ciprofloxacin.

• Ciprofloxacin is active against Morganella morganii in both in vitro and clinical infections.
• Ciprofloxacin can be used to treat Urinary Tract Infections and Skin and Skin Structure Infections caused by Morganella morganii. 2 2

From the Research

Treatment of Morganella morganii Infections

The recommended treatment for Morganella morganii infections is based on the severity of the infection and the patient's overall health.

• Antibiotic therapy is the primary treatment for M. morganii infections, with carbapenems, aminoglycosides, and ciprofloxacin being commonly used 3, 4.
• Source control measures, such as surgery, line removal, drainage, and tissue removal, may also be necessary to manage the infection 3.
• In some cases, combination therapy with gentamicin and a third-generation cephalosporin or another antibiotic to which M. morganii is susceptible may be effective 4.
• For early-onset neonatal sepsis caused by M. morganii, a combination of third-generation cephalosporin and aminoglycoside may be used 5.
• Topical and systemic antiparasitic therapy may also be considered in cases of myiasis-related M. morganii septicemia 6.

Antibiotic Resistance

M. morganii is often resistant to multiple antibiotics, including ciprofloxacin, trimethoprim/sulfamethoxazole, gentamicin, amoxicillin, nitrofurantoin, and colistin 3.

• Therefore, antibiotic susceptibility testing is crucial to guide treatment decisions.
• The use of broad-spectrum antibiotics, such as carbapenems, may be necessary to treat M. morganii infections, especially in cases of antibiotic resistance 3, 4.

Patient Outcomes

The outcome of M. morganii infections depends on various factors, including the severity of the infection, the patient's underlying health conditions, and the effectiveness of treatment.

• The in-hospital mortality rate for M. morganii bacteremia can be as high as 41% 3.
• Elderly patients and those with comorbidities, such as hypertension and diabetes, are at increased risk of mortality 3.
• Prompt and effective treatment, including source control measures and appropriate antibiotic therapy, is essential to improve patient outcomes 3, 4.