This document discusses treatment guidelines for Providencia infections. Providencia stuartii is typically the most resistant species and carbapenems are the recommended empirical treatment for life-threatening P. stuartii infections until identification and susceptibility testing can be done. P. alcalifaciens and P. rustigianii tend to be more susceptible to many antibiotics. Treatment should be narrowed once susceptibility is known and last 1-3 weeks depending on the infection site. Indwelling devices should be removed if associated with the infection.

1.  Medical care of Providencia infection includes initiation of an
antimicrobial agent to eradicate infection. Selection of an
empirical agent (while awaiting microbiological identification of the
organism and susceptibility testing) should be based on known
resistance patterns in the patient's locality (eg, community,
hospital, long-term care facility). Once the species of the
infecting Providencia pathogen has been identified (but before
susceptibilities are available), selection of an empiric antimicrobial
agent can be based on known patterns of susceptibility across
species, as detailed below.
 G

2.  P stuartii is typically the most resistant of all Providencia species.
A 2006 Italian study found that ESBL-positive P stuartii made up
10% of all ESBL species and had marked resistance to
amoxicillin-clavulanate (81.8%), ampicillin-sulbactam (40.1%),
gentamicin (79.5%), and ciprofloxacin (84.1%). In another study,
53% of P stuartii strains isolated were found to produce ESBL.[10]
 Carbapenems are the best choice for empirical therapy in life-
threatening infections or nosocomial outbreaks suspected to be
caused by P stuartii until speciation is confirmed.
 Amikacin and beta-lactam/beta-lactamase inhibitors such as
piperacillin/tazobactam are good first-line agents in non–life-
threatening infections.[15]
 P alcalifaciens and P rustigianii tend to be the most susceptible
of theProvidencia species. Although often resistant to
tetracyclines, older penicillins, and cephalosporins, they are
usually susceptible to TMP-SMX, fluoroquinolones,
aminoglycosides, late-generation cephalosporins, aztreonam,
and carbapenems.
 P rettgeri tends to fall between the two groups mentioned above
with regard to its susceptibility profile.
 Once the identity of the pathogen and its susceptibility profile are
known, target therapy with the most narrow-spectrum agent to
which the organism is susceptible.

3.  Duration of therapy should range from 1-3 weeks, depending on
the site of infection (14 d for bacteremia; 14-21 d for complicated
or catheter-associated urinary tract infection).
 If infection is associated with an indwelling device (eg, urinary
catheter), remove the catheter. Carefully evaluate the continued
need for the catheter. If its use continues to be required, insert a
new catheter. If not, discontinue use of the catheter.
Next Section: Surgical Care
Abstract
Out of 75 patients in whom nosocomial infection of the urinary tract occurred following operation for
disturbance of micturition 43 (57.3%) suffered clinically manifest inflammatory complications, however
only in 26 cases (34.6%) was this germ the cause. In the remaining 17 cases there were superinfections.
From these results it is concluded that the isolated Providencia stuartii strains were not very virulent. In
cases of asymptomatic providencia-bacteriuria the authors consider specific antibacterial therapy to be
indicated only if the excretion of germs does not cease spontaneously after micturition has been restored
to normal.