CASE SERIES OF EMERGING NOSOCOMIAL MULTIPLE DRUG RESISTANT PATHOGEN PROVIDENCIA RETTGERI CAUSING URINARY TRACT INFECTION

MAYURI MAHAJAN; PRASANNA S.; NIKUNJA KUMAR DAS; NIKHIL MAHAJAN

doi:10.22159/ijpps.2023v15i1.46740

Authors

MAYURI MAHAJAN Department of Microbiology and Pathology, Dr Hedgewar Hospital and Research Centre, Akola https://orcid.org/0000-0002-1271-8605
PRASANNA S. Department of Microbiology, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Chengalpattu, Tamil Nadu 603108
NIKUNJA KUMAR DAS Department of Microbiology, D.Y Patil Medical College Hospital and Research center, DY Patil Vidyapeeth, Pimpri, Pune
NIKHIL MAHAJAN Clinical Consultant and Head, Pediatrics and neonatology, Dr Hedgewar Hospital and Research Centre, Akola https://orcid.org/0000-0003-0403-0832

DOI:

https://doi.org/10.22159/ijpps.2023v15i1.46740

Keywords:

Emerging, Nosocomial pathogens, Multi-drug-resistant

Abstract

We report Case Series of Emerging Nosocomial Multiple Drug Resistant Pathogen Providencia rettgeri causing Urinary Tract Infections. The most common cause of catheter-associated urinary tract infections (CAUTI), especially with long-term indwelling urinary catheters in elders, are P. rettgeri and P. stuartii. We are reporting 4 cases of UTI, which are hospital-acquired and CAUTI. These cases are admitted to MICU for treatment purposes and later develop fever spikes after a few days and are evaluated and urine culture showed multi-drug-resistant Providencia rettgeri by VITEK. The empirical therapy was discontinued, managed with fosfomycin, and discharged later with follow-up. The various reports showed P. rettgeriis susceptible for amikacin, gentamicin, tobramycin and ciprofloxacin. In our case series, we isolated multi-drug-resistant strains of P. rettgeri that showed resistance to piperacillin-tazobactam, cefuroxime, ceftriaxone, cefepime, ertapenem, imipenem, meropenem, gentamicin, tobramycin, ciprofloxacin, tigecycline, amikacin, colistin and sensitive only to fosfomycin. The significance of P. rettgeri in association with catheter-related bloodstream infections (CRBSI) and catheter-associated urinary tract infections (CAUTI) was unclear. Hence isolation of Providencia species twice from the clinical samples was considered for association with catheter infections. The proper selection of empirical antimicrobials, antibiotic sensitivity testing, avoiding misuse of antibiotics and implementing proper drug holiday and local antibiotic policy are considered appropriate combination protocol for managing emerging multi-drug-resistant nosocomial Providencia rettgeri strains.

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