Providencia Infections Follow-up

Updated: May 31, 2017
  • Author: Edward Charbek, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Follow-up

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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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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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, as follows:

  • 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. [19]

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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