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Providencia Infections Treatment & Management

  • Author: Edward Charbek, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Aug 28, 2015
 

Medical Care

See the list below:

  • Medical care of Providencia infection includes initiation of an antimicrobial agent to eradicate infection. Selection of an empirical agent (while awaiting microbiological identification of the organism and susceptibility testing) should be based on known resistance patterns in the patient's locality (eg, community, hospital, long-term care facility). Once the species of the infecting Providencia pathogen has been identified (but before susceptibilities are available), selection of an empiric antimicrobial agent can be based on known patterns of susceptibility across species, as detailed below.
    • Generally, Providencia species are almost always resistant to tetracyclines, older penicillins, and cephalosporins, with susceptibility to late-generation cephalosporins, aztreonam, imipenem, and meropenem. Providencia species have variable susceptibilities to fluoroquinolones, aminoglycosides, and trimethoprim-sulfamethoxazole (TMP-SMX).
    • P stuartii is typically the most resistant of all Providencia species. A 2006 Italian study found that ESBL-positive P stuartii made up 10% of all ESBL species and had marked resistance to amoxicillin-clavulanate (81.8%), ampicillin-sulbactam (40.1%), gentamicin (79.5%), and ciprofloxacin (84.1%). In another study, 53% of P stuartii strains isolated were found to produce ESBL.[10]
    • Carbapenems are the best choice for empirical therapy in life-threatening infections or nosocomial outbreaks suspected to be caused by P stuartii until speciation is confirmed.
    • Amikacin and beta-lactam/beta-lactamase inhibitors such as piperacillin/tazobactam are good first-line agents in non–life-threatening infections.[15]
    • P alcalifaciens and P rustigianii tend to be the most susceptible of the Providencia species. Although often resistant to tetracyclines, older penicillins, and cephalosporins, they are usually susceptible to TMP-SMX, fluoroquinolones, aminoglycosides, late-generation cephalosporins, aztreonam, and carbapenems.
    • P rettgeri tends to fall between the two groups mentioned above with regard to its susceptibility profile.
    • Once the identity of the pathogen and its susceptibility profile are known, target therapy with the most narrow-spectrum agent to which the organism is susceptible.
    • Duration of therapy should range from 1-3 weeks, depending on the site of infection (14 d for bacteremia; 14-21 d for complicated or catheter-associated urinary tract infection).
  • If infection is associated with an indwelling device (eg, urinary catheter), remove the catheter. Carefully evaluate the continued need for the catheter. If its use continues to be required, insert a new catheter. If not, discontinue use of the catheter.
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Surgical Care

If Providencia infection is associated with an anatomic site amenable to debridement (eg, wound, ulcer) or drainage (eg, abscess), perform these procedures to facilitate bacterial eradication.

Surgical correction of any underlying genitourinary pathology (eg, benign prostatic hyperplasia [BPH], ureteric stricture, nephrolithiasis, tumors) or removal of foreign objects (eg, nephrostomy tubes, ureteral stents) may also help assist with eradication of the infection.

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Consultations

Consider consultation with an infectious diseases specialist to help determine the treatment plan.

Consider consultation with a urologist if a suspected structural genitourinary pathology is the underlying etiology of the infection.

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Diet

No special diet is required in patients with Providencia infections.

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Activity

Activity should not be restricted in patients with Providencia infections.

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Contributor Information and Disclosures
Author

Edward Charbek, MD Fellow in Pulmonary/Critical Care Medicine, St Louis University Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Nirav Patel, MD Assistant Professor of Internal Medicine, Division of Infectious Diseases, Allergy and Immunology and Division of Pulmonary, Critical Care, and Sleep Medicine, St Louis University School of Medicine; Interim Chief Medical Officer, Director of Antibiotic Stewardship, Infection Control Officer, St Louis University Hospital

Nirav Patel, MD is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, Missouri State Medical Association, Society for Healthcare Epidemiology of America, Society of Critical Care Medicine, Infectious Diseases Society of St Louis, St Louis Metropolitan Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Joshua S Hawley-Molloy, MD Staff Physician, Infectious Disease Service, Associate Program Director, Internal Medicine Residency, Department of Medicine, Tripler Army Medical Center

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

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

Joshua S Hawley-Molloy, MD Staff Physician, Infectious Disease Service, Associate Program Director, Internal Medicine Residency, Department of Medicine, Tripler Army Medical Center

Joshua S Hawley-Molloy, 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.

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.

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