Medical Care
Cultures with susceptibility data are recommended, when available, to guide antimicrobial therapy. Most Proteus strains are susceptible to commonly used antibiotics, except nitrofurantoin and tetracycline. Like other members of Enterobacteriaceae, multidrug-resistant (MDR) strains of Proteus exist and are increasing in frequency; strains of P vulgaris generally are more resistant.
Recommended empiric treatment includes the following:
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Uncomplicated UTIs in women can be treated on an outpatient basis with an oral quinolone for 3 days or trimethoprim/sulfamethoxazole (TMP/SMZ) for 3 days.
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Acute uncomplicated pyelonephritis in women can be treated with oral quinolones for 7-14 days, single-dose ceftriaxone or gentamicin followed by TMP/SMZ, or an oral cephalosporin or quinolone for 14 days as outpatient therapy. For hospitalized patients, therapy consists of parenteral (or oral once the oral route is available) ceftriaxone, quinolone, gentamicin (plus ampicillin), or aztreonam until defervescence. Then, an oral quinolone, cephalosporin, or TMP/SMZ for 14 days may be added to complete treatment.
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Complicated UTIs in men and women can be treated with a 10- to 21-day course of oral therapy (in the same manner as for hospitalized patients) as long as the follow-up is adequate.
Surgical Care
If struvite renal calculus is associated with Proteus infection, it must be removed to avert severe clinical outcomes and to avoid persistent sources that can lead to recurrent infection.
Most nonurologic infections result in abscesses. Radical surgical debridement is the cornerstone of successful therapy. Amputation may be necessary if skin or muscle necrosis of an extremity is the presenting infection, but tissue recovery is often better than expected. Broad-spectrum antimicrobial therapy is started empirically and is modified by the results of smears and cultures. Mortality and morbidity rates are high, even with adequate treatment.
Consultations
The discovery of stones requires an evaluation by a physician knowledgeable in the short- and long-term management of stones, typically a urologist or nephrologist.
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After 24 hours, this inoculated MacConkey agar culture plate cultivated colonial growth of gram-negative, rod-shaped, and facultatively anaerobic Proteus vulgaris bacteria. Courtesy of the CDC.
