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Antimicrobial Agents and Chemotherapy, July 2005, p. 2598-2605, Vol. 49, No. 7
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.7.2598-2605.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Proteus mirabilis Bloodstream Infections: Risk Factors and Treatment Outcome Related to the Expression of Extended-Spectrum ß-Lactamases

Andrea Endimiani,1 Francesco Luzzaro,1 Gioconda Brigante,1 Mariagrazia Perilli,2 Gianluigi Lombardi,1 Gianfranco Amicosante,2 Gian Maria Rossolini,3 and Antonio Toniolo1*

Laboratorio di Microbiologia, Ospedale di Circolo and Università dell'Insubria, I-21100 Varese,1 Dipartimento di Scienze e Tecnologie Biomediche, Università di L'Aquila, I-67100 L'Aquila,2 Dipartimento di Biologia Molecolare, Sezione di Microbiologia, Università di Siena, I-53100 Siena, Italy3

Received 22 December 2004/ Returned for modification 22 February 2005/ Accepted 18 March 2005

Bloodstream infection (BSI) due to Proteus mirabilis strains is a relatively uncommon clinical entity, and its significance has received little attention. This study was initiated to evaluate risk factors and treatment outcome of BSI episodes due to P. mirabilis producing extended-spectrum ß-lactamases (ESBLs). Twenty-five BSI episodes caused by P. mirabilis occurred at our hospital (Ospedale di Circolo e Fondazione Macchi, Varese, Italy) over a 7.5-year period. Phenotypic and molecular methods were used to assess ESBL production. Clinical records of BSI patients were examined retrospectively. Demographic data, underlying diseases (according to McCabe and Jackson classification and Charlson weighted index), risk factors, and treatment outcome were investigated by comparing cases due to ESBL-positive strains to cases due to ESBL-negative strains. Eleven isolates were found to express ESBLs (TEM-52 or TEM-92). The remaining 14 isolates were ESBL negative and were uniformly susceptible to extended-spectrum cephalosporins and monobactams. Comparison of the two groups showed that previous hospitalization in a nursing home (P = 0.04) and use of bladder catheter (P = 0.01) were significant risk factors for infections due to ESBL-positive strains. In addition, cases due to ESBL-positive strains showed a significantly higher mortality attributable to BSI (P = 0.04). BSI cases due to ESBL-negative isolates uniformly responded to therapy, whereas 5/11 cases due to ESBL-positive isolates failed to respond (P < 0.01). Use of carbapenems was associated with complete response independently of ESBL production. Therapeutic failure and mortality may occur in BSI episodes caused by ESBL-positive P. mirabilis isolates. Thus, recognition of ESBL-positive strains appears to be critical for the clinical management of patients with systemic P. mirabilis infections.

* Corresponding author. Mailing address: Laboratorio di Microbiologia, Ospedale di Circolo e Università dell'Insubria, Viale Borri 57, 21100 Varese, Italy. Phone: 39-0332-278309. Fax: 39-0332-260517. E-mail for Antonio Toniolo: antonio.toniolo{at}ospedale.varese.it. E-mail for Andrea Endimiani: aendimiani{at}tin.it.

Antimicrobial Agents and Chemotherapy, July 2005, p. 2598-2605, Vol. 49, No. 7
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.7.2598-2605.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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