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Proteus mirabilis bacteremia: a review of 176 cases during 1980-1992
1Department of Internal Medicine, St. Elizabeth Hospital Medical Center, Youngstown, Ohio 44501-1790.
Abstract:
Patients with Proteus mirabilis bacteremia at a large community teaching hospital during a 13-year period (1980-1992) were retrospectively reviewed. There were 176 patients whereof 44 (25%) had polymicrobial bacteremia. The median age of patients was 75 years and 64.2% were 70 years or older. Of the patients 56.8% came from a nursing home, 64.2% had an indwelling Foley catheter, and 20.5% nosocomial bacteremia. The most common source of bacteremia was the urinary tract (52.8%) whereas the lower respiratory tract was an uncommon source. Hypotension was present in 30.1% of patients. The overall mortality rate was 29.0% with an attributable mortality rate of 25.6%. The mortality rate of polymicrobial bacteremia (38.6%) was higher than that of monomicrobial bacteremia (25.8%). For patients with monomicrobial bacteremia, significant increase in mortality was found in patients who had nosocomial infection (p < 0.02), whose source of bacteremia was other than the urinary tract (p < 0.01), who had ultimately fatal underlying conditions (p < 0.01), who had hypotension (p < 0.001), who had increase in serum creatinine (p < 0.05), or who had increase in serum bilirubin (p < 0.05).
Insights
Proteus mirabilis bacteremia disproportionately affects elderly patients, often linked to urinary tract infections and catheters. Polymicrobial infections and specific clinical factors significantly increase mortality risk in these patients.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Proteus mirabilis is a common cause of urinary tract infections and bacteremia, particularly in elderly and institutionalized patients.
- Understanding risk factors and outcomes associated with P. mirabilis bacteremia is crucial for effective patient management.
- Previous studies have not extensively detailed the characteristics and mortality predictors of P. mirabilis bacteremia in a large community teaching hospital cohort.
Purpose of the Study:
- To retrospectively analyze the clinical characteristics, sources, and outcomes of patients with Proteus mirabilis bacteremia.
- To compare mortality rates between monomicrobial and polymicrobial P. mirabilis bacteremia.
- To identify factors associated with increased mortality in patients with P. mirabilis bacteremia.
Main Methods:
- Retrospective review of 176 patients with P. mirabilis bacteremia over a 13-year period (1980-1992).
- Data collected included patient demographics, comorbidities, source of infection, presence of indwelling devices, and clinical outcomes.
- Statistical analysis was performed to identify factors associated with mortality.
Main Results:
- The median patient age was 75 years, with 64.2% aged 70 or older. A significant proportion (56.8%) were from nursing homes, and 64.2% had indwelling Foley catheters.
- The urinary tract was the most common source (52.8%). Overall mortality was 29.0%, with polymicrobial bacteremia having a higher mortality rate (38.6%) than monomicrobial bacteremia (25.8%).
- Factors significantly associated with increased mortality in monomicrobial cases included nosocomial infection, non-urinary tract source, fatal underlying conditions, hypotension, and elevated serum creatinine and bilirubin.
Conclusions:
- Proteus mirabilis bacteremia predominantly affects elderly, institutionalized patients and is often associated with urinary tract issues.
- Polymicrobial infections and specific clinical factors like hypotension and non-urinary sources are associated with higher mortality.
- Early recognition and management of risk factors are essential to improve outcomes in patients with P. mirabilis bacteremia.