Background: The genus Providencia, earlier considered a rare pathogen, is now increasingly recognized as a notorious opportunistic pathogen capable of causing serious nosocomial infections, mainly urinary tract infections (UTIs). Treating these infections is an onerous task given the resistance seen in clinical strains to many currently available antimicrobials. The objective of the present study is to provide an overall view into the prevalence of Providencia spp. causing UTIs, their antibiotic susceptibility pattern, and respective clinical outcomes.
Materials and methods: This is a retrospective observational study carried out in a tertiary care teaching referral hospital located in Jaipur, India from March 2021 to May 2021. All Providencia spp. strains isolated from urine samples were included in the study. Data were entered in Microsoft Office Excel worksheet. Results are presented in numbers and percentages.
Results: Out of 1,261 urine samples processed in the laboratory during the study period, 426 were culture positive and the majority were gram-negative isolates and included Escherichia coli (46.0%) and Klebsiella spp. (28.0%). Providencia spp. was the fourth most common gram-negative pathogen (6.0%). The median age of patients was 65 years. The male:female ratio was 3:2 and maximum patients belonged to the 30–60-year age-group. Diabetes was the commonest associated comorbidity. All patients had an indwelling urinary catheter. Three (20.0%) patients succumbed to infections.
Conclusion:Providencia is an opportunistic pathogen that cannot be neglected due to escalating antibiotic resistance. Effective infection control and antibiotic stewardship policies are required to prevent the development of further antibiotic resistance.
O'Hara CM, Brenner FW, Miller JM. Classification, identification, and clinical significance of Proteus, Providencia, and Morganella. Clin Microbiol Rev 2000;13(4):534–546. DOI: 10.1128/CMR.13.4.534.
Hee KC, Young KK, Hyo YK, Jeong EP, Young Uh. Clinical and microbiological features of Providencia bacteremia: experience at a tertiary care hospital. Korean J Intern Med 2015;30(2):219–225. DOI: 10.3904/kjim.2015.30.2.219.
Sharma D, Sharma P, Soni P. First case report of Providencia rettgeri neonatal sepsis. BMC Res Notes 2017;10(1):536. DOI: 10.1186/s13104-017-2866-4.
Gupta B, Kachru N. A fatal case of Providencia sepsis. Urol Androl Open J 2017;2(1):4–7. DOI: 10.17140/UAOJ-2-112.
Siddharth S, Nagalakshmi N, Jessica DS. Providencia rettgeri: an emerging nosocomial uropathogen in an indwelling urinary catheterised patient. J Clin Diagn Res 2017;11(6):1–2. DOI: 10.7860/JCDR/2017/25740.10026.
Maiti TK, Pandey P, Singh VK. Providencia rettgeri: an unusual cause of central nervous system infections. Am J Med Sci 2013;346(2):158–159. DOI: 10.1097/MAJ.0b013e318294f998.
Shiwani S, Prapti B, Nidhi S, Varsha G, Jagdish C. Isolation of Morganella morganii and Providencia species from clinical samples in a tertiary care hospital in North India. Infect Disord Drug Targets 2021;21(1):84–89. DOI: 10.2174/1871526520666200128162646.
Abdallah M, Balshi A. First literature review of carbapenem-resistant Providencia. New Microbes New Infect 2018;25:16–23. DOI: 10.1016/j.nmni.2018.05.009.
Mataseje LF, Boyd DA, Lefebvre B, Bryce E, Embree J, Gravel D, et al. Complete sequences of a novel blaNDM-1-harbouring plasmid from Providencia rettgeri and an FII-type plasmid from Klebsiella pneumoniae identified in Canada. J Antimicrob Chemother 2014;69(3):637–642. DOI: 10.1093/jac/dkt445.
Tatsuya T, Tohru MA, Rajan KD, Manoj KS, Hiroshi O, Kayo S, et al. NDM-1 Metallo-β-lactamase and ArmA 16S Rrna methylase producing Providencia rettgeri clinical isolates in Nepal. BMC Infect Dis 2014;14:56. DOI: 10.1186/1471-2334-14-56.
Saeam S, Seok HJ, Hyukmin L, Jun SH, MinJeong P, Wonkeun S. Emergence of multidrugresistant Providencia rettgeri isolates coproducing NDM1 carbapenemase and PER1 extendedspectrum βlactamase causing a first outbreak in Korea. Ann Clin Microbiol Antimicrob 2018;17(1):20. DOI: 10.1186/s12941-018-0272-y.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multi drug resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268–281. DOI: 10.1111/j.1469-0691.2011.03570.x.
Vijay S, Bansal N, Rao BK, Veeraraghavan B, Rodrigues C, Wattal C, et al. Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience. Infect Drug Resist 2021;14:1893-1903. DOI: 10.2147/IDR.S299774.
Li J, Wang J, Yang Y, Peisham C, Jingchao C, Xuefeng C, et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: a retrospective analysis. Antimicrob Resist Infect Control 2020;9:153. DOI: 10.1186/s13756-020-00819-1.
Hayakawa K, Marchaim D, Divine GW, Pogue JM, Sarwan K, Lephart P, et al. Growing prevalence of Providencia stuartii associated with the increased usage of colistin at a tertiary health care center. Int J Infect Dis 2012;16:e646–e648. DOI: 10.1016/j.ijid.2012.05.1029.
McHale PJ, Walker F, Scully B, English L, Keane CT. Providencia stuartii infections: a review of 117 cases over an eight year period. J Hosp Inf 1981;2(1):155–165. DOI: 10.1016/0195-6701(81)90024-4.
Krake, PR, Tandon N. Infective endocarditis due to Providenca stuartii. South Med J 2004;97(10):1022–1023. DOI: 10.1097/01.smj.0000141308.19657.ba.
Unverdi S, Akay H, Ceri M, Inal S, Altay M, Demiroz AP, et al. Peritonitis due to Providencia stuartii. Perit Dial Int 2011;31(2):216–217. DOI: 10.3747/pdi.2010.0017.
Sipahi OR, Bardak-Ozcem S, Ozgiray E, Aydemir S, Yurtseven, T, Yamazhan T, et al. Meningitis due to Providencia stuartii. J Clin Microbiol 2010;48(12):4667–4668. DOI: 10.1128/jcm.01349-10.
Godebo G. Kibru G, Tassew H. Multidrug-resistant bacterial isolates in infected wounds at Jimma University Specialized Hospital, Ethiopia. Ann Clin Microbiol Antimicrob 2013;12:17. DOI: 10.1186/1476- 0711-12-17.
Linhares I, Raposo T, Rodrigues A, Almeida A. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009). BMC Infect Dis 2013;13:19. DOI: 10.1186/1471- 2334-13-19.
Giovanni B, Mariagrazia P, Stefania S, Gianfranco S, Giuseppe N. Prevalence of extended spectrum β-lactamases among Enterobacteriaceae: an Italian survey panel. Int J Antimicrob Agents 2002;19(3):213–217. DOI: 10.1016/s0924-8579(01)00497-6.
Fass RJ, Barnishan J, Ayers LW. Emergence of bacterial resistance to imipenem and ciprofloxacin in a university hospital. Journal Antimicrob Chemother 1995;36(2):343–353. DOI: 10.1093/jac/36.2.343.
Miroslav F, Miroslav L, Pavla P, Lenka R, Jaroslav P, Josef K, et al. The susceptibility to fosfomycin of Gram negative bacteria isolates from urinary tract infection in the Czech Republic: data from a unicentric study. BMC Urol 2017;17(1):33. DOI: 10.1186/s12894-017-0222-6.
Amela DJ, Mirsada H. Catheter related urinary tract infections in patients suffering from spinal cord injuries. Bosn J Basic Med Sci 2009;9(1):2–9. DOI: 10.17305/bjbms.2009.2849.
Sivoneide M da S, Barbara De AR, Ana VAL, Rafael ACQ de Sa, Jailton LQ De Sa, Maria AVM, et al. Providencia stuartii isolates in Brazil. Rev Soc Bras Med Trop 2021;54:e20190524. DOI: 10.1590/0037-8682- 0524-2019.