Proteus bacteriuria is associated with significant morbidity in spinal cord injury

Abstract

Study Design: Retrospective chart review. Objectives: We investigated the morbidity associated with Proteus bacteriuria in a spinal cord injured (SCI) population. Setting: Michael E DeBakey Veterans Affairs Medical Center in Houston, Texas, USA. Methods: We reviewed the medical records of all veterans with SCI who received care in our medical center during the past 3 years. Proteus bacteriuria was defined as the growth of Proteus species in any urine culture during the study period. Urinary stones were defined as either renal or bladder calculi. Results: During the study period, 71 of the 501 subjects (14%) had Proteus and 90 (18%) had urinary stones. Twenty-seven percent of the subjects with Proteus had stones, and the association of Proteus with stones was significant (Po0.05). Proteus bacteriuria was likewise associated with complete injury, hospitalization, decubitus ulcers, and history of stones (Po0.001). Subjects using indwelling catheters, either transurethral or suprapubic, were significantly more likely to have Proteus, whereas subjects practising spontaneous voiding and clean intermittent catheterization were significantly less likely to have Proteus. In the 90 patients with stones, Proteus was associated with requiring treatment for stones and having multiple stones (Po0.01). Twenty-five of the 90 patients with stones (28%) required treatment, most often with lithotripsy, and 6 (7%) developed urosepsis. Conclusions: In persons with SCI, Proteus was found in subjects with a greater degree of impairment who were more likely to be hospitalized, to have decubiti, and to use indwelling catheters. Bacteriuria with Proteus predicted urologic complications in persons with SCI. Statement of Ethics: All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Proteus mirabilisand Urinary Tract Infections

“…In 2006, UTIs in the United States were the cause of 11 million physician visits and cost $3.5 billion dollars (10). This organism is more common in complicated urinary tract infections (such as patients with spinal cord injury or anatomical abnormality) and especially contributes to catheter-associated UTI (CAUTI), causing 10-44% of long-term CAUTIs at a cost of $43-256 million in the US annually (6, 11, 12). The wide range of P. mirabilis CAUTI likely reflects differences in the population surveyed and the types of samples collected.…”

Pathogenesis of Proteus mirabilis Infection

“…While the bacterium is capable of causing a variety of human infections, including those of wounds, the eye, the gastrointestinal tract, and the urinary tract, it is most noted for infections of the catheterized urinary tract, known as catheter-associated urinary tract infections (CAUTI) (4–9). These infections are common in long-term catheterized patients, such as those who reside in nursing homes and chronic care facilities, and may be of particular danger to spinal cord injury patients (10). Urinary tract infections (UTIs) and CAUTIs involving P. mirabilis are typically complicated by the formation of bladder and kidney stones (urolithiasis) and permanent renal damage (11–13), and may progress to bacteremia and sepsis (14, 15).…”

The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control

“…40 It is also clear that in these patients, bacteriuria with P. mirabilis is associated with significant morbidity. Hung et al, for example, 41 after a retrospective chart review of a population with spinal cord injury concluded that the presence of P. mirabilis in the bladder is not a benign condition rather it is a good predictor of urological complications. To facilitate a better understanding of the epidemiology and pathogenesis of these P. mirabilis infections, Sabbuba et al 42 developed a method for its genotyping.…”