Introduction
The genus Providencia is gram-negative urease-producing bacilli that cause many human infections. They cause urinary tract infections but can also cause gastroenteritis and bacteremia. These are uncommon and primarily hospital-borne infections. The prevalence of these infections increases due to extended-spectrum beta-lactamase activity (bacteria can resist the effect of antibiotics). The bacterium was initially seen in chickens. However, the five species of the genus Providencia are prevalent in humans. These include Providencia stuartii, P. rettgeri, P. alcalifaciens, P. rustigianii, and P. heimbachae. Several other illnesses are being reported more frequently, including burns, pneumonia, neonatal sepsis, and community and hospital-acquired central nervous system infections.
What Is the Pathophysiology of Providencia Infection?
Reservoirs of Providencia species are found in multiple animals, such as flies, birds, cats, dogs, cattle, sheep, guinea pigs, penguins, and reptiles. Providencia species are common in soil, water, and sewage. Neonatal diarrhea in dairy cows caused by infection of P. stuartii. Enteritis in dogs caused by P. alcalifaciens. P. rettgeri causes meningitis in crocodiles and meningitis along with enteritis in chicken. P. heimbachae is seen in penguin feces and an aborted bovine fetus.
Providencia species are found in human urine (most common), stool, and blood. Also seen in human sputum, skin, and cultures obtained from wounds. P. stuartii causes infective endocarditis in humans. P. rettgeri is a cause of eye infections in humans, such as keratitis, conjunctivitis, and endophthalmitis. P. stuartii is usually isolated from urinary catheters. The bacteria stay in the urinary tract due to the presence of an adhesin substance that allows bacteria to stick to urinary catheters. Such attachment is accentuated by the presence of fimbriae in the bacteria. The prevalence of P. stuartii is more seen in females than males.
P. alcalifaciens, P. rettgeri, and P. stuartii commonly cause gastroenteritis in humans.
What Are the Clinical Features of Providencia Infection?
Common symptoms of infections with Providencia are gastrointestinal symptoms. These are such as nausea, vomiting, diarrhea, and abdominal pain. The most common symptoms of P. alcalifaciens infection are watery diarrhea (blood-associated), abdominal pain, dry mucous membrane, flank pain, suprapubic tenderness, and a fever.
P. alcalifaciens infection is mainly seen in overseas travelers. Patients with Providencia urinary tract infections develop long-standing dependence on an indwelling (present inside the body) urinary catheter. As a result, urinary tract infections show symptoms such as dysuria (abnormal urination timing), polyuria (frequent episodes of urination), hematuria (blood in urine), and fever or chills. P. rettgeri and P. stuartii are the etiologic agents in traveler's diarrhea. P. rettgeri mainly causes gastrointestinal infection (vomiting most common). However, these species can also lead to respiratory tract infections. Symptoms are pneumonia, cough, and fever or chills.
Burn patients are at a greater risk of Providencia wound infection.
What Are the Causes of Providencia Infection?
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Urinary Tract Infection: Urinary tract infection is mainly due to P. stuartii and is less commonly associated with P. rettgeri. But P. rettgeri is associated with long-term indwelling urinary devices and in cases of complicated cystitis.
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Other Conditions: Most patients affected with Providencia infections are used to being in long-term care facilities. Such patients are at greater risk of obstruction (tumor), foreign bodies, and functional disturbances in the body.
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Gastroenteritis: P. alcalifaciens, P. rettgeri, and P. stuartii infections develop gastroenteritis after a journey to developing countries.
What Is the Risk Factor Associated With Providencia Infection?
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Race: Equal susceptibility to Providencia infection is seen in all races.
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Sex: Males and females are equally susceptible to Providencia infection.
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Age: Old persons are at greater risk than young ones. However infection with species Alcalifaciens gastroenteritis is more common in children and adults.
What Are the Complications Associated With Providencia Infection?
When Providencia infections get involved in the bloodstream, numerous complications arise, as follows:
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Sepsis or vascular collapse.
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Renal failure.
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Pneumonia.
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ARDS (acute respiratory distress syndrome).
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Gastrointestinal tract infection and thus causes bloody diarrhea and severe dehydration.
What Is the Treatment for Providencia Infection?
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Medical Care: It includes antimicrobial therapy. Medical care for Providencia infection includes initiating an antimicrobial agent to eradicate the infection. First, starting with an empirical agent ( a drug given before exact microbiological identification of the microorganism and before susceptibility testing). Then, particular medicine should be given after identifying particular species of the Providencia pathogen. Generally, Providencia species are resistant ( do not respond to treatment) to Tetracyclines, older Penicillins, and Cephalosporins but susceptible to late-generation Cephalosporins, Aztreonam, Imipenem, and Meropenem. Therefore, integrated therapy should be given. For empirical therapy, Carbapenems are the best choice in life-threatening infections or nosocomial diseases. Mainly depends upon the site of infection; the duration of therapy is one to three weeks.
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Catheter Removal: Removal of the cause can cure the condition, so if the infection is associated with an indwelling device such as a urinary catheter, then removal of the catheter becomes necessary. If removal is not possible, then place a new catheter. So a careful evaluation is done before the continued need for the catheter.
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Surgical Care: If Providencia infection leads to deterioration of any anatomic site, such as a wound, or ulcer, then debridement should be done carefully. In case of an abscess (pus) formation, drainage becomes necessary. These procedures should be performed to facilitate bacterial eradication. Surgical correction is done in cases of genitourinary pathology tumors, benign prostatic hyperplasia, ureteric strictures, and nephrolithiasis. Surgery is also required to remove foreign objects, such as nephrostomy tubes and ureteral stents. These also help assist in eradicating the infection.
What Is the Prognosis for Providencia Infection?
The mortality rate in the case of Providencia bloodstream infections is high. It is proven that early appropriate antimicrobial therapy decreases mortality in severe infections. Risk is more remarkable in cases of polymicrobial infection.
Conclusion
Providencia infections are bacterial infections that are gram-negative and urease-positive. These cause blood infections, gastroenteritis, and urinary tract infections in humans. It also infects the wound and ulcer of a person. Early diagnosis and early antibiotic therapy can stop the bloodstream infection. Infection control practices help in the management of Providencia species because choosing an empiric antimicrobial agent is very difficult.
