What is Proteus (bacterial infection)?

From the Guidelines

Proteae infections, particularly those caused by Proteus mirabilis, should be treated with fluoroquinolones (such as ciprofloxacin 500mg twice daily for 7-14 days) or third-generation cephalosporins (like ceftriaxone 1-2g daily), as these are typically effective against these gram-negative bacteria 1. When considering treatment options for Proteae infections, it is essential to note that these bacteria are commonly found in soil, water, and the human intestinal tract, and are notable causes of urinary tract infections, especially in patients with urinary catheters or structural abnormalities. Some key points to consider when treating Proteae infections include:

• The production of urease by these bacteria, which breaks down urea into ammonia and creates an alkaline environment that promotes stone formation and bacterial persistence 1.
• The importance of proper identification through culture and susceptibility testing to guide targeted treatment, as these organisms can develop antibiotic resistance 1.
• The potential need for combination therapy in cases of complicated infections 1.
• The consideration of local resistance patterns and specific host factors, such as allergies, when selecting antimicrobial therapy 1. In terms of specific treatment recommendations, the European Association of Urology guidelines suggest that treatment for 7-14 days is generally recommended, but the duration should be closely related to the treatment of the underlying abnormality 1.

From the Research

Proteae Overview

• Proteus mirabilis is a common cause of complicated urinary tract infections (UTIs) 2, 3, 4
• UTIs caused by Proteus mirabilis can lead to serious complications, including bacteremia and septicemia 4
• The bacterium's urease activity can contribute to the formation of bladder and kidney stones, making infections harder to treat 3

Risk Factors and Clinical Outcomes

• Risk factors for multi-drug resistant Proteus mirabilis UTIs include younger age, other concomitant infectious diseases, and prior therapy with antipseudomonal penicillin 2
• Independent risk factors for MDR-PM UTI include empiric cephalosporin therapy and prior antipseudomonal penicillin therapy during the last year 2
• Community-acquired infection, hydronephrosis, and band neutrophils accounting for >10% of the white blood cell count are independent risk factors for P. mirabilis bacteremic UTI 4

Treatment and Prevention

• The current clinical paradigm for the treatment of UTIs involves the use of antibiotics, but the efficacy of this approach is dwindling due to rising antimicrobial resistance 5
• There is an urgent need for new antibiotics and non-antibiotic treatment and prevention strategies for UTIs 5
• Vaccination against Proteus mirabilis is a potential strategy for preventing UTIs, with studies investigating the use of mucosal vaccines conjugated to cholera toxin 3

Antibiotic Sensitivity

• The antibiotic sensitivity of Proteus mirabilis strains can vary by sex, season, and year 6
• Female patients may respond better to levofloxacin, while male patients may respond better to sulfamethoxazole 6
• Seasonal variation in antibiotic sensitivity has been observed, with higher rates of sensitivity to certain antibiotics during certain times of the year 6