What is the treatment for Providencia stuartii in stool?

Treatment of Providencia stuartii in Stool

For Providencia stuartii isolated from stool, antibiotic treatment is generally not recommended unless there are signs of invasive infection, as it is often considered colonization rather than true infection requiring specific antimicrobial therapy. 1

Evaluation of Clinical Significance

When P. stuartii is isolated from stool, consider the following:

• Colonization vs. Infection: Most stool isolates represent colonization rather than active infection
• Clinical symptoms: Assess for:
  • Diarrhea
  • Abdominal pain
  • Fever
  • Systemic symptoms suggesting invasive infection

Treatment Approach

For Asymptomatic Colonization

• No treatment is required for asymptomatic colonization
• Avoid unnecessary antibiotics which may promote resistance

For Symptomatic Infection

If clinical symptoms suggest active infection with P. stuartii (rare from stool isolates alone):

1. First-line treatment options:

   • Cefepime IV (active against Providencia stuartii) 2
   • Carbapenem-sparing regimens are preferred due to increasing resistance concerns 1

2. Alternative options (based on susceptibility testing):

   • Ceftolozane/tazobactam with metronidazole 1
   • Trimethoprim-sulfamethoxazole (if susceptible)
   • Fluoroquinolones or third-generation cephalosporins with metronidazole 1

Special Considerations

Multidrug Resistance

P. stuartii has emerged as an important nosocomial pathogen with concerning resistance patterns 3:

• Often carries ESBL enzymes (SHV-5, VEB-1)
• May harbor carbapenemase genes (VIM-1)
• Frequently resistant to aminoglycosides and fluoroquinolones

Biofilm Formation

P. stuartii has significant biofilm-forming capability, particularly in catheterized patients, which may complicate treatment 4, 5:

• Consider catheter removal if urinary tract is the suspected source
• Longer duration of therapy may be needed for biofilm-associated infections

Treatment Duration

• For uncomplicated infections: 7-10 days
• For complicated infections: 14 days or longer based on clinical response

Monitoring

• Clinical response should be evident within 48-72 hours
• Follow-up cultures may be warranted in persistent symptoms
• Monitor for emergence of resistance during therapy

Prevention

• Strict infection control measures for hospitalized patients
• Proper catheter care in catheterized patients
• Judicious use of antibiotics to prevent resistance development

Caution

The presence of P. stuartii in stool may indicate potential for urinary tract colonization/infection, particularly in catheterized patients, as 92% of bacteremic P. stuartii infections have been associated with long-term indwelling Foley catheters 6.