Proteus Bacteriuria: Ominous Urinary Marker

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Proteus bacteriuria may be a marker for poor urinary health in spinal-cord injury (SCI) patients.

 

Researchers at Baylor College of Medicine in Houston studied 501 patients (98% male) with SCI who received care at the Houston Veterans Affairs Medical Center. Fifty-one percent of the patients had incomplete injury and 49% had complete injury.

 

The patients had a median age of 57 years, and 60% were white. The median time since injury was 15 years. Proteus bacteriuria was detected in 41 patients with complete injury (22.7%) compared with 30 patients (9.4%) with incomplete injury, a significant difference. Proteus bacteriuria also was associated with decubitus ulcers and hospitalization.

 

Of the 501 subjects, 91 (18%) had a history of stones, and 19 of these patients (21%) had Proteus bacteriuria compared with 52 (12.7%) of the remaining 410 patients. During the 36-month study period, stones were diagnosed in 90 patients. Proteus bacteriuria was significantly associated with the need for stone treatment and having multiple stones, the researchers concluded.

 

In terms of bladder management, stones were associated only with suprapubic catheters. Twenty-five (28%) of the 90 patients required treatment, most often with lithotripsy. Urosepsis developed in six of these patients (7%).

Patients using indwelling catheters, either transurethral or suprapubic, were much more likely to have Proteus compared with subjects practicing spontaneous voiding and subjects with clean intermittent catheterization, said lead investigator Barbara Trautner, MD, assistant professor of medicine. The latter two forms of bladder management were associated with a decreased risk of having Proteus bacteriuria. The researchers observed no association between Proteus bacteriuria and external catheter use.

“These findings are important for several reasons,” Dr. Trautner said. “Our study confirms that the presence of Proteus in the bladder is not a benign condition and may be a marker for poor urinary tract health. Proteus is very hard to eliminate from the catheterized urinary tract, and a more effective approach to clearing this organism is needed. We anticipate using our findings to design future clinical studies targeting this pathogen.”

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