Providencia Infections Follow-up

  • Author: Joshua S Hawley, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

Further Inpatient Care

  • In addition to antimicrobial therapy, inpatient care for Providencia infections may include supportive and general medical care for manifestations that require hospitalization (eg, pneumonia, acute respiratory distress syndrome [ARDS], bloodstream infection, dehydration).
  • If infection is associated with an indwelling device, such as a urinary catheter, carefully re-evaluate the continued need for this device.
  • For urinary tract infections, recommend strict measurement of intake and output. Consider bladder scanning in cases of suspected neurogenic bladder.
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Further Outpatient Care

  • Monitor the patient for resolution of clinical manifestations and potential toxicities of antibiotics.
  • Infection may recur, particularly if an indwelling device remains in place. If repeat cultures after treatment continue to demonstrate the organism, clinical evidence of infection should be sought. The urine may continue to be colonized after a course of antibiotic treatment, especially in the presence of an indwelling device (eg, urinary catheter, condom catheter).
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Inpatient & Outpatient Medications

  • Administration of antibiotics, based on susceptibility testing, should be continued for 7-21 days depending on clinical picture (bacteremia, complicated urinary tract infection).
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Transfer

  • Transfer patients if they develop complications that require therapeutic options that the initial treating facility cannot provide (eg, mechanical ventilation, hemodialysis).
  • If a patient is being transferred to another medical institution (eg, skilled nursing facility, long-term care facility) following treatment, convey the nature of the infecting organism to the receiving facility. This allows institution of appropriate infection control precautions, if needed.
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Deterrence/Prevention

  • Considering the association of Providencia infections with indwelling devices (eg, urinary catheters, ureteral stent), a careful review of the medical necessity of any such devices is extremely important. The need for such devices should be reviewed periodically, and they should be removed, if possible.
  • If an indwelling device is required, meticulous care of such devices is important in reducing the likelihood of colonization and infection.
  • Providencia species are rarely isolated in uncomplicated urinary tract infections. Correction of underlying abnormalities associated with complicated urinary tract infections reduces the risk of Providencia infection. Examples include correction of obstruction (tumors, stones, ureteric strictures) and treatment of functional disorder (neurogenic bladder, vesicoureteral reflux).
  • Travelers to developing countries should be counseled to avoid raw or undercooked foods and to drink bottled water. Pre-travel referral to a travel medicine specialist may reduce the risk of travel-related illness.
  • Providencia species are often resistant to multiple antibiotics. Early identification of such infections and prompt institution of infection-control procedures are important for decreasing the likelihood of spread of the organism among patients.
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Complications

  • P stuartii and P rettgeri infections, particularly when they involve the bloodstream, have been associated with numerous complications.
    • Sepsis/vascular collapse
    • Renal failure
    • Pneumonia
    • ARDS
  • Providencia gastrointestinal tract infection may be associated with bloody diarrhea and dehydration.
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Prognosis

  • The mortality rate among patients with Providencia bloodstream infection ranged from 6-33% in one review.[14]
  • Patients with polymicrobial bacteremia are at an increased risk of mortality.
  • Evidence that early appropriate antimicrobial therapy is associated with decreased mortality likelihood is inconclusive.
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Contributor Information and Disclosures
Author

Joshua S Hawley, MD  Staff, Department of Infectious Disease; Associate Program Director, Resident of Internal Medicine, Department of Medicine, Tripler Army Medical Center

Joshua S Hawley, MD is a member of the following medical societies: American College of Physicians, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Evan G Brown, DO  Resident Physician, Department of Internal Medicine, Tripler Army Medical Center

Evan G Brown, DO is a member of the following medical societies: American College of Physicians and American Osteopathic Association

Disclosure: Nothing to disclose.

Leanne B Gasink, MD, MSc  Assistant Professor, Department of Medicine and Faculty-Fellow, Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine; Associate Hospital Epidemiologist, Hospital of the University of Pennsylvania

Disclosure: Johnson and Johnson Salary Employment

Ebbing Lautenbach, MD, MPH  Director of Infection Control, Presbyterian Medical Center, Assistant Professor, Department of Medicine, Division of Infectious Disease, University of Pennsylvania School of Medicine

Ebbing Lautenbach, MD, MPH is a member of the following medical societies: American College of Epidemiology, American College of Physicians, Infectious Diseases Society of America, Society for Epidemiologic Research, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Kenneth C Earhart, MD  Deputy Head, Disease Surveillance Program, United States Naval Medical Research Unit #3

Kenneth C Earhart, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Charles V Sanders, MD  Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The views expressed in this abstract/manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

References

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