From the Guidelines
Proteus mirabilis infections in patients with heart failure and atrial fibrillation (afib) require careful selection of antibiotics.
- The most appropriate respiratory antibiotics for P. mirabilis in this context are carbapenems, such as ertapenem, imipenem/cilastatin, meropenem, or doripenem, due to their broad-spectrum activity against gram-positive and gram-negative aerobic and anaerobic pathogens, including P. mirabilis 1.
- Alternatively, beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin/tazobactam, may be considered, although their use in patients with ESBL-producing infections is still controversial 1.
- Ceftazidime and cefoperazone are third-generation cephalosporins with activity against P. aeruginosa, but may not be effective against P. mirabilis 1.
- Tigecycline is not effective against P. mirabilis and should not be used as a first-line treatment 1.
- Aminoglycosides may be effective against P. mirabilis, but their use is limited due to toxic side effects and the need for combination with other antibiotics 1.
- New antibiotics, such as ceftolozane/tazobactam and ceftazidime/avibactam, have shown promise in treating multidrug-resistant gram-negative infections, including P. mirabilis, but their role in empiric treatment remains to be defined 1.
- In patients with hospital-acquired pneumonia (HAP), antibiotics with activity against P. aeruginosa and other gram-negative bacilli, such as carbapenems or beta-lactam/beta-lactamase inhibitor combinations, are recommended 1.
From the Research
Appropriate Respiratory Antibiotics for Proteus (P.) mirabilis
In a patient with heart failure and atrial fibrillation (afib), the choice of antibiotic for treating Proteus (P.) mirabilis infections is crucial. The following points highlight the appropriate respiratory antibiotics for P. mirabilis:
- Ceftriaxone and Ciprofloxacin: A study 2 reported the successful treatment of P. mirabilis endocarditis with 6 weeks of ceftriaxone and long-term oral ciprofloxacin.
- Dual Antibiotic Therapy: Another study 3 found that dual antibiotic therapy was successfully administered for 6 weeks in a patient with P. mirabilis endocarditis.
- Carbapenems and Piperacillin/Tazobactam: Research 4 suggests that carbapenems and piperacillin/tazobactam can be effective in treating bacteremia caused by extended-spectrum β-lactamase-producing P. mirabilis.
- Bacteriophages: A study 5 explored the use of bacteriophages as a potential therapeutic option for treating multidrug-resistant P. mirabilis infections, including biofilm-based infections.
Considerations for Heart Failure and Afib
When treating P. mirabilis infections in patients with heart failure and afib, it is essential to consider the following:
- Underlying Conditions: The patient's underlying conditions, such as heart failure and afib, may affect the choice of antibiotic and the treatment regimen.
- Antibiotic Resistance: The increasing resistance of P. mirabilis to antimicrobial agents 5, 4 highlights the need for careful selection of antibiotics and consideration of alternative treatment options.
- Individualized Treatment: Each patient's treatment should be individualized based on their specific needs, medical history, and the results of susceptibility testing 6, 4.