Proteus species

Background:

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Enterobacteriaceae  (Gram Negative Bacilli)  
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>Citrobacter species:
     1] Citrobacter koseri
     2] Citrobacter freundii
>Enterobacter species
     1] Enterobacter cloacae,
     2] Enterobacter aerogenes)
>Escherichia coli
>Klebsiella species:
     1] Klebsiella ozaenae
     2] Klebsiella pneumoniae
     3] Klebsiella rhinoscleromatis
>Morganella species 
     1] (Morganella morganii)
>Proteus species: led
     1] Proteus mirabilis
     2] Proteus vulgaris
>Providencia species:
     1] Providencia_rettgeri
     2] Providencia stuartii
>Salmonella species:
     1] Salmonella enteritidis
     2] Salmonella typhi
     3] Other
>Serratia marcescens
>Shigella species:  
     1] Shigella dysenteriae (serogroup A)
     2] Shigella flexneri
     3] Shigella boydii
     4] Shigella sonnei
     5] Other

Proteus

  • Gram-negative, oxidase-negative,  catalase- and nitrate-positive, and urease positive.
  • Widely distributed in nature as saprophytes, being found in decomposing animal matter, in sewage, in manure soil, and in human and animal feces.
  • They are opportunistic pathogens, commonly responsible for urinary and septic infections, often nosocomial. Three species – P. vulgaris, P. mirabilis, and P. penneri –  are opportunistic human pathogens.
  • On the species level, indole is considered reliable, as it is positive for Proteus vulgaris but negative for Proteus mirabilis.
  • Most strains produce a powerful urease enzyme, which rapidly hydrolyzes urea to ammonia and carbon monoxide.

 

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Therapy:

Important considerations:  The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions.   Generally, the most common agents/regimens are listed first.  Listed dosages may need to be adjusted for renal dysfunction.  

Proteus mirabilis:

  1. Ceftin (cefuroxime oral) 250-500mg orally twice daily
  2. Augmentin 875/125 mg orally twice daily
  3. Ciprofloxacin 500-750 mg orally q12h or 400mg IV q12h
  4. Levofloxacin 500mg – 750 mg IV/PO once daily
  5. Ceftriaxone 1-2 grams IV q24h 

Proteus vulgaris:

  1. Ciprofloxacin 500-750 mg orally q12h or 400mg IV q12h
  2. Levofloxacin 500mg – 750 mg IV/PO once daily
  3. Ceftriaxone 1-2 grams IV q24h 
  4. Cefepime 1-2 grams IV every 8-12 hours
  5. Imipenem 500mg IV every 6 hours [Range: 250-1000 mg q6-8h]

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer