Association of Proteus mirabilis and Providencia stuartii Infections with Diabetes.

Maria Rus,Silvana Vulpie,Oana Magiar,Luminita Mirela Baditoiu,Monica Licker,Teodora Sorescu,Silvia Ioana Musuroi,Adela Voinescu,Corina Musuroi,Delia Muntean

doi:10.3390/medicina58020271

Maria Rus, Silvana Vulpie + Show 8 more

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https://doi.org/10.3390/medicina58020271

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Abstract

Background and Objectives: Proteus and Providencia are related genera of opportunistic pathogens belonging to the Morganellaceae family, often a cause of infections in the immunocompromised hosts, such as diabetic patients. Their clinical significance has increased due to their intrinsic resistance to polymyxins, which is often associated with acquired resistance mechanisms. In this study we evaluated the infections caused by Proteus mirabilis and Providencia stuartii in two groups of patients, with diabetes (group 1) and without diabetes (group 2) admitted to the intensive care unit and surgical wards. The infections were investigated in terms of infection type, risk factors, clinical course, predictive factors for unfavourable outcomes and antibiotic resistance profile. Materials and Methods: An observational, retrospective, cross-sectional study was conducted, comprising all patients infected with these pathogens. Bacterial identification and antibiotic sensitivity testing were performed using the Vitek2C automated system. Results: Comparison of the two groups showed that the statistically significant common infectious risk factors were found less frequently among diabetic patients when compared with non-diabetic patients, and that antimicrobial resistance was significantly lower in the diabetic patient group. However, survival rates did not differ between the two groups, drawing attention to the implications of diabetes as comorbidity. Additionally, with regard to the antibiotic resistance profile, 38.89% of P. stuartii strains isolated from diabetic patients belonged to the difficult-to-treat (DTR) phenotype, contributing to the severity of these infections compared with those caused by P. mirabilis, of which 32% were wild type strains and 0% were DTR phenotype. The DTR/extended spectrum beta-lactamase producing P. stuartii isolates more than doubled the risk of mortality, while the presence of nasogastric nutrition tripled the risk. Conclusions: P. stuartii infections that occurred in diabetic patients proved to be more difficult to treat, the majority of them being healthcare-associated bacteremias.

Highlights

People with diabetes are more prone to develop infections compared with the general population [1,2]
The aim of this study was to assess P. mirabilis and P. stuartii infections in diabetic and non-diabetic patients admitted to the intensive care unit (ICU) and surgical wards, with regard to risk factors, type of infection, clinical progression, and predictive factors for unfavourable outcomes and resistance phenotypes, respectively
In order to highlight the impact of diabetes as a comorbidity, the sample of patients was subdivided into two groups: Group 1 (G1)—All patients who developed infections with pathogens belonging to the two species identified above and who had been previously diagnosed with type 1 or type 2 diabetes mellitus (DM); latent autoimmune diabetes of the adult (LADA) or maturity-onset diabetes of the young (MODY); patients with prediabetic conditions, gestational diabetes, or with other specific types of diabetes secondary to exocrine pancreatic diseases, endocrine pathology (Cushing’s syndrome, hyperthyroidism), or genetic pathology (Down syndrome), as well as those with hyperglycaemia secondary to glucocorticoid therapy, thiazide diuretics, etc

Summary

Introduction

People with diabetes are more prone to develop infections compared with the general population [1,2]. Proteus and Providencia are related genera of opportunistic pathogens belonging to the Morganellaceae family, often a cause of infections in the immunocompromised hosts, such as diabetic patients. Their clinical significance has increased due to their intrinsic resistance to polymyxins, which is often associated with acquired resistance mechanisms. With regard to the antibiotic resistance profile, 38.89% of P. stuartii strains isolated from diabetic patients belonged to the difficult-to-treat (DTR) phenotype, contributing to the severity of these infections compared with those caused by P. mirabilis, of which 32% were wild type strains and 0% were DTR phenotype. Conclusions: P. stuartii infections that occurred in diabetic patients proved to be more difficult to treat, the majority of them being healthcare-associated bacteremias

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