Medical Care

M morganii strains are naturally resistant to penicillin, ampicillin, ampicillin/sulbactam, oxacillin, first-generation and second-generation cephalosporins, erythromycin, tigecycline, colistin, and polymyxin B.

Most strains are naturally susceptible to piperacillin, ticarcillin, mezlocillin, third-generation and fourth-generation cephalosporins, carbapenems, aztreonam, fluoroquinolones, aminoglycosides, and chloramphenicol. A systematic review found gentamicin to be the most common and successfully used antibiotic alongside another susceptible antibiotic.^[25]

The widespread use of third-generation cephalosporins has been associated with the emergence of highly resistant M morganii, as follows:

Many hospital-acquired strains express derepressed chromosomal ampC beta-lactamases (Bush group 1) similar to those produced by Pseudomonas aeruginosa and Enterobacter species.^[26]
These strains may be resistant to ceftazidime and other third-generation cephalosporins, but they usually are susceptible to cefepime, imipenem, meropenem, piperacillin, the aminoglycosides, and fluoroquinolones.
The beta-lactamase inhibitors (ie, clavulanic acid, sulbactam) are ineffective against these enzymes; however, the combination of piperacillin and tazobactam is more effective than piperacillin alone.
Rare isolates of M morganii produce extended-spectrum beta-lactamases (ESBLs). These enzymes hydrolyze drugs such as ceftazidime, cefotaxime, and aztreonam but have little effect on the cephamycins (ie, cefoxitin, cefotetan). ESBLs are inhibited by clavulanic acid.

Resistance by M morganii also has been proposed to harbor new multi-drug resistant genes via a novel Transposon Tn 7376 alongside mobile genetic elements (MGEs), particularly the IS26-flanked MGE carrying the extra gene dfrA24 in an isolated pathogenic variant.^[27]

Surgical Care

Drain any abscesses. Aggressive surgical drainage is required for brain abscesses caused by M morganii.

Debride any surgical wounds.

Consultations

Consultations with a microbiologist, an infection control specialist, and/or an infectious diseases specialist may be warranted.

Prevention

Prevent M morganii infection by observing appropriate infection control practices and judiciously using beta-lactam antibiotics.

Medication

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Author

Shirin A Mazumder, MD, FIDSA Associate Professor of Medicine, Director of Infectious Disease Fellowship Program, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, University of Tennessee Methodist Physicians

Shirin A Mazumder, MD, FIDSA is a member of the following medical societies: American Academy of HIV Medicine, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Memphis Medical Society, Society for Healthcare Epidemiology of America, Tennessee Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Nupur Singh, BA MD Candidate, University of Tennessee Health Science Center College of Medicine

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.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University School of Medicine in Shreveport; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

James R Miller, MD Assistant Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences; Consulting Staff, Pediatric Infectious Diseases, Naval Medical Center at Portsmouth

James R Miller, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Sections Morganella Infections
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