• MAYURI MAHAJAN Department of Microbiology and Pathology, Dr Hedgewar Hospital and Research Centre, Akola
  • 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



Emerging, Nosocomial pathogens, Multi-drug-resistant


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.


Download data is not yet available.


O’Hara CM, Brenner FW, Miller JM. Classification, identification, and clinical significance of Proteus, Providencia, and Morganella. Clin Microbiol Rev. 2000;13(4):534-46. doi: 10.1128/CMR.13.4.534, PMID 11023955.

Armbruster CE, Smith SN, Yep A, Mobley HL. Increased incidence of urolithiasis and bacteremia during proteus mirabilis and providencia stuartii coinfection due to synergistic induction of urease activity. J Infect Dis. 2014;209(10):1524-32. doi: 10.1093/infdis/jit663, PMID 24280366.

Hawkey PM. Providencia stuartii: a review of a multiply antibiotic-resistant bacterium. J Antimicrob Chemother. 1984;13(3):209-26. doi: 10.1093/jac/13.3.209, PMID 6373713.

Warren JW. Providencia stuartii: a common cause of antibiotic-resistant bacteriuria in patients with long-term indwelling catheters. Rev Infect Dis. 1986;8(1):61-7. doi: 10.1093/clinids/8.1.61, PMID 3081988.

Jones BD, Mobley HL. Genetic and biochemical diversity of ureases of proteus, Providencia, and Morganella species isolated from urinary tract infection. Infect Immun. 1987;55(9):2198-203. doi: 10.1128/iai.55.9.2198-2203.1987, PMID 3623698.

Darouiche RO. Device-associated infections: a macroproblem that starts with microadherence. Clin Infect Dis. 2001;33(9):1567-72. doi: 10.1086/323130, PMID 11577378.

Al-Jubouri MA, Vardhan MS. A case of purple urine bag syndrome associated with Providencia rettgeri. J Clin Pathol. 2001;54(5):412. doi: 10.1136/jcp.54.5.412-a, PMID 11328846.

Tada T, Miyoshi Akiyama T, Dahal RK, Sah MK, Ohara H, Shimada K. 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, PMID 24484534.

Müller HE. Occurrence and pathogenic role of organelle-proteus-Providencia group bacteria in human feces. J Clin Microbiol. 1986;23(2):404-5. doi: 10.1128/jcm.23.2.404-405.1986, PMID 3517057.

Yoh M, Matsuyama J, Ohnishi M, Takagi K, Miyagi H, Mori K. Importance of Providencia species as a major cause of travellers’ diarrhoea. J Med Microbiol. 2005;54(11):1077-82. doi: 10.1099/jmm.0.45846-0, PMID 16192440.

Koreishi AF, Schechter BA, Karp CL. Ocular infections caused by Providencia rettgeri. Ophthalmology. 2006;113(8):1463-66. doi: 10.1016/j.ophtha.2006.03.047, PMID 16797710.

Wie SH. Clinical significance of Providencia bacteremia or bacteriuria. Korean J Intern Med. 2015;30(2):167-9. doi: 10.3904/kjim.2015.30.2.167, PMID 25750557.

Marchandin H, Carriere C, Sirot D, Pierre HJ, Darbas H. TEM-24 produced by four different species of Enterobacteriaceae, including providencia rettgeri, in a single patient. Antimicrob Agents Chemother. 1999;43(8):2069-73. doi: 10.1128/AAC.43.8.2069, PMID 10428940.

Cornaglia G, Frugoni S, Mazzariol A, Piacentini E, Berlusconi A, Fontana R. Activities of oral antibiotics on providencia strains isolated from institutionalized elderly patients with urinary tract infections. Antimicrob Agents Chemother. 1995;39(12):2819-21. doi: 10.1128/AAC.39.12.2819, PMID 8593030.

Barrios H, Garza Ramos U, Reyna Flores F, Sanchez Perez A, Rojas Moreno T, Garza Gonzalez E. Isolation of carbapenem-resistant NDM-1-positive providencia rettgeri in mexico. J Antimicrob Chemother. 2013;68(8):1934-6. doi: 10.1093/jac/dkt124. PMID 23620464.

Usharani P. Incidence and outcome of multidrug-resistant aerobic gram-negative bacteria causing various clinical infections. Asian J Pharm Clin Res. 2021. Dec 15;2:123-6. doi: 10.22159/ajpcr.2022.v15i2.43436.

Mehta A, Kr Diwakar M. Characterization and antimicrobial susceptibility profile of non-lactose fermenting gram-negative bacterial isolates in a tertiary care teaching hospital of central India. Asian J Pharm Clin Res. 2021. Oct;14(10):41-7. doi: 10.22159/ajpcr.2021.v14i10.42822.

Fass RJ, Barnishan J, Ayers LW. Emergence of bacterial resistance to imipenem and ciprofloxacin in a university hospital. J Antimicrob Chemother. 1995;36(2):343-53. doi: 10.1093/jac/36.2.343, PMID 8522464.

Blaser MJ, Dolin R, Mandell GL, Douglas RG1, Bennett JE, Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier/Saunders; 2015.

Wang TK, Ahn Y, Dunlop J. Providencia rettgeri peritonitis in a patient on peritoneal dialysis with perforated appendicitis. Perit Dial Int. 2014;34(5):569-70. doi: 10.1177/089686081403400501, PMID 25075004.



How to Cite

MAHAJAN, M., P. S., N. K. DAS, and N. MAHAJAN. “CASE SERIES OF EMERGING NOSOCOMIAL MULTIPLE DRUG RESISTANT PATHOGEN PROVIDENCIA RETTGERI CAUSING URINARY TRACT INFECTION”. International Journal of Pharmacy and Pharmaceutical Sciences, vol. 15, no. 1, Jan. 2023, pp. 40-43, doi:10.22159/ijpps.2023v15i1.46740.



Case Study(s)