Molecular epidemiology of catheter-associated bacteriuria in nursing home patients

Abstract

Urine samples from 19 nursing home patients with long-term urinary catheters were cultured every 3 months for 18 months. Providencia stuartii, present in 74% of the elderly and in 59% of urine specimens, was the most frequently isolated bacteria. The persistence of P. stuartii was significantly higher among females than among males. In order to study the epidemiology of bacteriuria in this nursing home, bacteria were characterized by biochemical tests, antibiotic susceptibility patterns, and restriction fragment length polymorphism (RFLP) analysis. The antibiotic susceptibility pattern indicated that each patient had two to three different strains of P. stuartii during the 18 months of follow-up. In contrast, the RFLP analysis revealed that a specific strain had persisted in the urinary tract of the patient during the entire follow-up period. According to the biochemical profile, 74% of the patients had the same bacteria in urine cultures, pointing to a common source of transmission. RFLP analysis, however, demonstrated different patterns of RFLP, suggesting concomitant multiple sources of infection.

Arginine promotes Proteus mirabilis motility and fitness by contributing to conservation of the proton gradient and proton motive force

“…Proteus mirabilis poses a significant challenge for hospitals and long-term care facilities due to its ability to quickly traverse catheters to reach the urinary tract (Stickler and Hughes 1999;Sabbuba et al 2002;Jacobsen et al 2008), urease-mediated alkalinization of urine leading to catheter encrustation and urolithiasis (Griffith et al 1976;Jones et al 1990), and persistence within the urinary tract despite catheter changes and antibiotic treatment (Warren et al 1982;Kunin 1989;Rahav et al 1994). This bacterium possesses numerous virulence factors that contribute to colonization and ascension of the urinary tract, including fimbriae and other adhesins, urease, hemolysin, IgA protease, siderophores and metal transport systems, and flagellum-mediated motility (Armbruster and Mobley 2012).…”

Recurrent Primary Suprahepatic Abscess Due to Providencia Stuartii: A Rare Phenomenon

“…In a 12-year study in Ohio Hospital, P. stuartii was the source of bacteremia in 49 patients [ 3 ], where 78% of the cases are above 70 years, 96% are from a nursing home, while 92% have chronic Foley catheters on admission. The incidence is rising and found in 54% of urine samples (74% of elderly) collected from indwelling or condom catheters of bedridden patients [ 4 ].…”

Case report: Providencia stuartii conjunctivitis

“…P. stuartii is an increasingly common bacterium found in the urine of nursing home residents with indwelling Foley catheters [ 2 ]. In a 12-year study from a large community hospital in Ohio, P. stuartii was found to cause bacteremia in 49 patients [ 1 ].…”

“…The genus Providencia includes five facultative gram-negative bacilli, of which Providencia stuartii is the species most commonly causing infection [ 1 ]. P. stuartii has been increasingly isolated from urine cultures in nursing home residents with long-term urinary catheters [ 2 ]. It is particularly common in patients with blocked indwelling urinary catheters [ 3 ] and is also an uncommon cause of bacteremia [ 1 ].…”