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Year : 2011  |  Volume : 55  |  Issue : 4  |  Page : 411-413  

Proteus penneri lurking in the intensive care unit: An important often ignored nosocomial pathogen

Department of Microbiology, Government Medical College Hospital, Chandigarh, India

Date of Web Publication13-Sep-2011

Correspondence Address:
Neha Bansal
Department of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh - 160 030
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5049.84842

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How to cite this article:
Kaistha N, Bansal N, Chander J. Proteus penneri lurking in the intensive care unit: An important often ignored nosocomial pathogen. Indian J Anaesth 2011;55:411-3

How to cite this URL:
Kaistha N, Bansal N, Chander J. Proteus penneri lurking in the intensive care unit: An important often ignored nosocomial pathogen. Indian J Anaesth [serial online] 2011 [cited 2021 Jul 30];55:411-3. Available from: https://www.ijaweb.org/text.asp?2011/55/4/411/84842

Patients in the intensive care unit (ICU) carry a poor prognosis not only owing to their critical illness but also due to predisposition to nosocomial infections. In addition to their association with increased morbidity and mortality, patients have to bear the onslaught of nosocomial infections with drug-resistant microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and extended spectrum β-lactamase (ESBL) producing Gram-negative bacteria, which can pose considerable therapeutic problems. [1] Nosocomial infections can affect any part of the body but respiratory tract infections are the most frequent in the ICU, followed by central line infections, urinary tract infections and wound infections. [2]

In the present report, we describe the isolation of Proteus penneri, a known nosocomial pathogen with underestimated pathogenic potential. Over a period of three months (January-March 2010), in a mini cluster outbreak, we isolated P. penneri from the different clinical samples of 11 ICU patients. The male:female ratio of these 11 patients was 7:4. Three patients were above 60 years of age while majority (seven patients) belonged to 20-60 years with one patient less than 20 years. The clinical diagnoses were as varied as perforation peritonitis, pulmonary oedema, chronic liver disease with post-operative pancreatic necrosectomy, diaphragmatic hernia with splenectomy, respiratory distress with C3-C6 cord oedema, bronchial asthma with cardiac arrest, fracture cervical spine with anterior decompression with stabilization, diabetes mellitus with hypertension and cerebrovascular accident, etc. All the patients were on mechanical ventilation and had urinary catheters inserted. Nine patients had central venous catheters as well. P. penneri was isolated from tracheobronchial secretions from 10 of these patients (repeated isolation in 6 patients) and from the abdominal drainage fluid from 1 patient. All isolations were in mixed cultures with either of Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter spp. The same isolate was recovered in pure cultures from urine in two patients and one of them also had bacteremia due to P. penneri. Mortality was the outcome in four patients, probably due to multiple reasons.

All the strains isolated had similar resistogram; they were resistant to augmentin, gentamicin, amikacin, ceftazidime and cefipime whereas these were sensitive to ciprofloxacin, cefoperazone/sulbactam, piperacillin/tazobactam and imipenem. All these patients were administered combination drugs along with imipenem and they responded clinically well with the subsequent cultures of tracheobronchial secretions showing no growth of P. penneri.

This bacterium belongs to the tribe Proteeae of family Enterobacteriaceae. In 1982, the name P. penneri was proposed for a group of bacteria previously known as Proteus vulgaris indole negative or P. vulgaris biogroup 1. [3] Regardless of its wide distribution, it was considered as an uncommon cause of infections in human beings. This has been isolated from many different clinical sources, including surgical wound infections, urine and blood. Nosocomial transmission, although uncommon, but has been reported. In a review of 27 cases, Krajden et al. documented the isolation of P. penneri from urine, abdominal, neck, groin, hip wounds, conjunctiva, sacral decubitus and sputum. [4] All of these were hospital-associated infections. It has been implicated in a case of bacteremia and concomitant subcutaneous thigh abscess in a neutropenic patient with acute lymphocytic leukemia [5] and in nosocomial urosepsis in a diabetic patient from whom the organism was also subsequently isolated from bronchoalveolar lavage fluid and a pulmonary artery catheter tip. [6] The urease enzyme of P. penneri is also believed to be a leading cause of kidney stone formation; indeed, the organism has been isolated from the center of a stone removed from a patient with persistent P. penneri bacteriuria. [3]

Although the number of cases in this report is limited, it is obvious that P. penneri is yet another agent capable of causing significant nosocomial infection and thus warrants appropriate antibiotic therapy. Virtually all P. vulgaris, P. penneri strains are capable of producing inducible β-lactamases that will hydrolyze primary and extended-spectrum penicillins and cephalosporins as highlighted by Liassine et al. in their report. [3],[7] Therefore, to conclude, infections due to nosocomial bacterium like P. penneri with proven pathogenicity in critically ill patients of ICU should not be dismissed lightly by the clinicians, instead these warrant appropriate therapeutic strategies combined with continued emphasis on effective infection control practices.

   References Top

1.Vincent JL. Nosocomial infections in adult intensive-care units. Lancet 2003;361:2068-77.  Back to cited text no. 1
2.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470-85.  Back to cited text no. 2
3.O'Hara CM, Brenner FW, Miller JM. Classification, identification and clinical significance of Proteus, Providencia and Morganella. Clin Microbiol Rev 2000;13:534-46.  Back to cited text no. 3
4.Krajden S, Fuksa M, Petrea C, Crisp LJ, Penner JL. Expanded clinical spectrum of infections caused by Proteus penneri. J Clin Microbiol 1987;25:578-9.  Back to cited text no. 4
5.Engler HD, Troy K, Bottone EJ. Bacteremia and subcutaneous abscess caused by Proteus penneri in a neutropenic host. J Clin Microbiol 1990;28:1645-6.  Back to cited text no. 5
6.Latuszynski DK, Schoch P, Qadir MT, Cunha BA. Proteus penneri urosepsis in a patient with diabetes. Heart Lung 1998;27:146-8.  Back to cited text no. 6
7.Liassine N, Labia R, Metral C, Ninet B, Madec S, Peron M, et al. Two Isolates of Proteus penneri, one ceftriaxone-susceptible and one ceftriaxone-resistant, isolated from a patient treated by ceftriaxone, produce the same beta-lactamase but with different levels of production. Abstr Intersci Conf Antimicrob Agents Chemother 2000;40:100.  Back to cited text no. 7

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