Bacteremia in a Multilevel Geriatric Hospital

Lubart, Emily; Segal, Refael; Haimov, Ella; Dan, Michael; Baumoehl, Yehuda; Leibovitz, Arthur

doi:10.1016/j.jamda.2010.02.017

Cited by 24 publications

(21 citation statements)

References 28 publications

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“…The highest incidence of P. mirabilis CAUTI occurs in elderly patients during long-term catheterization. P. mirabilis is also a common agent of Gram-negative bacteremia, particularly in patients with concurrent UTI; in recent studies, this species was found in 5-20% of these cases and as high as a 50% mortality rate in geriatric patients (13-16). …”

Section: Incidencementioning

confidence: 99%

Proteus mirabilisand Urinary Tract Infections

2015

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Proteus mirabilis is a Gram-negative bacterium which is well-known for its ability to robustly swarm across surfaces in a striking bulls’-eye pattern. Clinically, this organism is most frequently a pathogen of the urinary tract, particularly in patients undergoing long-term catheterization. This review covers P. mirabilis with a focus on urinary tract infections (UTI), including disease models, vaccine development efforts, and clinical perspectives. Flagella-mediated motility, both swimming and swarming, is a central facet of this organism. The regulation of this complex process and its contribution to virulence is discussed, along with the type VI-secretion system-dependent intra-strain competition which occurs during swarming. P. mirabilis uses a diverse set of virulence factors to access and colonize the host urinary tract, including urease and stone formation, fimbriae and other adhesins, iron and zinc acquisition, proteases and toxins, biofilm formation, and regulation of pathogenesis. While significant advances in this field have been made, challenges remain to combatting complicated UTI and deciphering P. mirabilis pathogenesis.

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Section: Incidencementioning

confidence: 99%

Proteus mirabilisand Urinary Tract Infections

2015

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“…Besides classical pathogens ( S. pneumoniae, Neisseria meningitides, Haemophilus influenzae ) the causative agents of CNS infections in persons with an impaired immune system are other bacteria including Gram-negative aerobic rods, group B streptococci, Nocardia spp. and Listeria monocytogenes (Bouadma et al, 2006; Cabellos et al, 2008, 2009; Gaschignard et al, 2011; Lubart et al, 2011). Immunocompromised patients also are susceptible to meningitis and encephalitis caused by a variety of fungi, most frequently Cryptococcus neoformans in AIDS patients and Aspergillus spp.…”

Section: Pathophysiological Aspects Of Acute or Chronic Cns Infectionsmentioning

confidence: 99%

Strategies to increase the activity of microglia as efficient protectors of the brain against infections

Nau

Ribes²,

Djukic

et al. 2014

Front. Cell. Neurosci.

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In healthy individuals, infections of the central nervous system (CNS) are comparatively rare. Based on the ability of microglial cells to phagocytose and kill pathogens and on clinical findings in immunocompromised patients with CNS infections, we hypothesize that an intact microglial function is crucial to protect the brain from infections. Phagocytosis of pathogens by microglial cells can be stimulated by agonists of receptors of the innate immune system. Enhancing this pathway to increase the resistance of the brain to infections entails the risk of inducing collateral damage to the nervous tissue. The diversity of microglial cells opens avenue to selectively stimulate sub-populations responsible for the defence against pathogens without stimulating sub-populations which are responsible for collateral damage to the nervous tissue. Palmitoylethanolamide (PEA), an endogenous lipid, increased phagocytosis of bacteria by microglial cells in vitro without a measurable proinflammatory effect. It was tested clinically apparently without severe side effects. Glatiramer acetate increased phagocytosis of latex beads by microglia and monocytes, and dimethyl fumarate enhanced elimination of human immunodeficiency virus from infected macrophages without inducing a release of proinflammatory compounds. Therefore, the discovery of compounds which stimulate the elimination of pathogens without collateral damage of neuronal structures appears an achievable goal. PEA and, with limitations, glatiramer acetate and dimethyl fumarate appear promising candidates.

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“…Urolithiasis in humans and animal models of infection can elicit bladder obstruction and renal damage (35, 38, 39), which facilitate sepsis and bacteremia. Indeed, P. mirabilis is the causative agent in 13-21% of bacteremias experienced by nursing home residents, the majority of which are secondary to CAUTI (9, 40–45). However, there are examples of catheterized patients with prolonged colonization by P. mirabilis who do not experience catheter blockage or urolithiasis (12, 46), indicating that the magnitude of struvite crystal formation is likely affected by other factors within the urinary tract environment.…”

Section: Introductionmentioning

confidence: 99%

A rare opportunist,Morganella morganii, decreases severity of polymicrobial catheter-associated urinary tract infection

Learman

Brauer

Eaton

et al. 2019

Preprint

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26Catheter-associated urinary tract infections (CAUTIs) are common hospital-acquired infections 27 and frequently polymicrobial, which complicates effective treatment. However, few studies 28 experimentally address the consequences of polymicrobial interactions within the urinary tract, 29 and the clinical significance of polymicrobial bacteriuria is not fully understood. Proteus 30 mirabilis is one of the most common causes of monomicrobial and polymicrobial CAUTI, and 31 frequently co-colonizes with Enterococcus faecalis, Escherichia coli, Providencia stuartii, and 32 Morganella morganii. P. mirabilis infections are particularly challenging due to its potent urease 33 enzyme, which facilitates formations of struvite crystals, catheter encrustation, blockage, and 34 formation of urinary stones. We previously determined that interactions between P. mirabilis and 35 other uropathogens can enhance P. mirabilis urease activity, resulting in greater disease severity 36 during experimental polymicrobial infection. Our present work reveals that M. morganii acts on 37 P. mirabilis in a contact-independent manner to decrease urease activity. Furthermore, M. 38 morganii actively prevents urease enhancement by E. faecalis, P. stuartii, and E. coli. 39 Importantly, these interactions translate to modulation of disease severity during experimental 40 CAUTI, predominantly through a urease-dependent mechanism. Thus, products secreted by 41 multiple bacterial species in the milieu of the catheterized urinary tract can directly impact 42 prognosis. 43 urolithiasis; urease 46 47Urinary catheters are common in health care settings, estimated to be utilized in ~60% of 48 critically ill patients, 20% of surgical unit patients, and 10% of nursing homes residents (1-3). 49The vast majority of individuals with an indwelling urinary catheter will experience bacteriuria 50 and may progress to catheter-associated urinary tract infection (CAUTI) (1). CAUTI is the most 51 common healthcare-associated condition in the United States, and carries an estimated economic 52 burden approaching $1.7 billion annually (4). 53 Bacteriuria in catheterized individuals rapidly becomes polymicrobial, involving 54 combinations of Proteus mirabilis, Enterococcus faecalis, Escherichia coli, Pseudomonas 55 aeruginosa, Klebsiella pneumoniae, Providencia stuartii, Morganella morganii, Citrobacter 56 species, Staphylococcus species, and Streptococcus species (1, 2, 5). It is estimated that 31-86% 57 of CAUTIs are also polymicrobial (6-14); however, urine specimens are often suspected of 58 harboring periurethral or vaginal microbiota if multiple colony types are observed, particularly if 59Gram-positive organisms are present, and are therefore often dismissed as "contamination" (15, 60 16). Thus, the clinical significance of polymicrobial bacteriuria is not fully understood. 61 There are numerous experimental and clinical examples of polymicrobial colonization 62 causing more severe disease than infection with a single bacterial species (monomicro...

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Bacteremia in a Multilevel Geriatric Hospital

Cited by 24 publications

References 28 publications

Proteus mirabilisand Urinary Tract Infections

Proteus mirabilisand Urinary Tract Infections

Strategies to increase the activity of microglia as efficient protectors of the brain against infections

A rare opportunist,Morganella morganii, decreases severity of polymicrobial catheter-associated urinary tract infection

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