Treatment of Providencia stuartii in Urine
For Providencia stuartii urinary tract infections, ciprofloxacin is the recommended first-line agent for susceptible strains, with piperacillin-tazobactam as an alternative for polymicrobial infections, and treatment duration should be 7-14 days depending on clinical context. 1, 2
Antimicrobial Selection
First-Line Therapy
- Ciprofloxacin is specifically FDA-approved for urinary tract infections caused by Providencia stuartii and should be used when susceptibility testing confirms the organism is susceptible 2
- The American College of Clinical Pharmacy specifically recommends ciprofloxacin for susceptible P. stuartii strains, particularly in urinary tract infections 1
- Ciprofloxacin should only be used empirically if local resistance rates are <10% 3
Alternative Agents
- Piperacillin-tazobactam is recommended for polymicrobial infections involving P. stuartii, which occur in approximately 51% of bacteremic cases 1, 4
- Consider third-generation cephalosporins (intravenous) as empirical treatment for complicated UTI with systemic symptoms 3
- Aminoglycosides combined with amoxicillin or second-generation cephalosporins can be used for complicated UTI 3
Critical Clinical Context
Catheter Management
- Catheter removal or replacement is essential - antibiotic therapy alone cannot clear biofilm on indwelling catheters and will only suppress symptoms temporarily 3
- P. stuartii is strongly associated with catheter-associated UTI (CAUTI), with 92% of bacteremic patients having long-term indwelling Foley catheters 4
- Relapse is highly likely if the catheter remains in place after treatment completion 3
Treatment Duration
- 7-14 days is the recommended duration for complicated UTI 3
- Use 14 days for men when prostatitis cannot be excluded 3
- Shorter 7-day courses may be considered when the patient is hemodynamically stable and afebrile for at least 48 hours 3
Important Caveats
Resistance Patterns
- P. stuartii exhibits significant multidrug resistance, with intrinsic resistance to tetracycline, penicillin, polymyxin, and nitrofurantoin 5
- Both chromosomal and plasmid-mediated resistance mechanisms are clinically important 5
- Always obtain urine culture and susceptibility testing before finalizing antibiotic selection 3
Polymicrobial Infection
- P. stuartii frequently causes polymicrobial infections, particularly with other catheter-associated organisms 4, 6
- When polymicrobial infection is suspected or confirmed, broader spectrum coverage with piperacillin-tazobactam is preferred 1
High-Risk Populations
- P. stuartii predominantly affects nursing home residents (96% in one series) and patients with long-term catheterization 4
- The urinary tract is the source in approximately 71-82% of bacteremic cases 4
- Hospital mortality in bacteremic patients is 25%, indicating this is not a benign colonizer 4
Colonization vs. Infection
- Distinguish true infection from colonization before initiating antimicrobial therapy 3
- Asymptomatic bacteriuria should not be treated except before urological procedures breaching the mucosa 3
- Look for systemic symptoms: fever, rigors, altered mental status, flank pain, costovertebral angle tenderness, or signs of sepsis 3