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Observational Study
. 2022 Feb 11;58(2):271.
doi: 10.3390/medicina58020271.

Association of Proteus mirabilis and Providencia stuartii Infections with Diabetes

Maria Rus  1 , Monica Licker  1   2   3 , Corina Musuroi  1   2 , Delia Muntean  1   2   3 , Silvana Vulpie  2 , Oana Magiar  2 , Teodora Sorescu  4   5 , Silvia Ioana Musuroi  6 , Adela Voinescu  2 , Luminita Mirela Baditoiu  3   7
Affiliations
Observational Study

Association of Proteus mirabilis and Providencia stuartii Infections with Diabetes

Maria Rus et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Proteus and Providencia are related genera of opportunistic pathogens belonging to the Morganellaceae family, often a cause of infections in the immunocompromised hosts, such as diabetic patients. Their clinical significance has increased due to their intrinsic resistance to polymyxins, which is often associated with acquired resistance mechanisms. In this study we evaluated the infections caused by Proteus mirabilis and Providencia stuartii in two groups of patients, with diabetes (group 1) and without diabetes (group 2) admitted to the intensive care unit and surgical wards. The infections were investigated in terms of infection type, risk factors, clinical course, predictive factors for unfavourable outcomes and antibiotic resistance profile. Materials and Methods: An observational, retrospective, cross-sectional study was conducted, comprising all patients infected with these pathogens. Bacterial identification and antibiotic sensitivity testing were performed using the Vitek2C automated system. Results: Comparison of the two groups showed that the statistically significant common infectious risk factors were found less frequently among diabetic patients when compared with non-diabetic patients, and that antimicrobial resistance was significantly lower in the diabetic patient group. However, survival rates did not differ between the two groups, drawing attention to the implications of diabetes as comorbidity. Additionally, with regard to the antibiotic resistance profile, 38.89% of P. stuartii strains isolated from diabetic patients belonged to the difficult-to-treat (DTR) phenotype, contributing to the severity of these infections compared with those caused by P. mirabilis, of which 32% were wild type strains and 0% were DTR phenotype. The DTR/extended spectrum beta-lactamase producing P. stuartii isolates more than doubled the risk of mortality, while the presence of nasogastric nutrition tripled the risk. Conclusions: P. stuartii infections that occurred in diabetic patients proved to be more difficult to treat, the majority of them being healthcare-associated bacteremias.

Keywords: ICU; P. mirabilis; P. stuartii; diabetic; non-diabetic.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The share of infected patients in the total number of diabetic/non-diabetic patients.
Figure 2
Figure 2
Distribution of diabetic and non-diabetic patients according to the profile of the ward.
Figure 3
Figure 3
Distribution of infections with P. mirabilis and P. stuartii in the studied time interval.
Figure 4
Figure 4
Distribution of surgical interventions/procedures performed in diabetic (A) and non-diabetic (B) patients.
Figure 5
Figure 5
Kaplan–Meier curves of the subjects in the two samples.
See this image and copyright information in PMC

References

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Supplementary concepts