Outbreak of a Nosocomial Infection with a Strain of Proteus rettgeri Resistant to Many Antimicrobials

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Abstract
Over a three-month period, Proteus rettgeri infections occurred in ten patients on one general medical ward. This organism was resistant to all antimicrobials tested by the Bauer-Kirby and tube dilution methods including tobramycin, gentamicin, kanamycin, carbenicillin, ampicillin, cephalothin, tetracycline, chloramphenicol, polymyxin and rifampin. Clinical Illness from this organism was directly related to local or systemic host deficiencies. Typically, patients were chronically ill with recent urinary tract instrumentation and infection and previous antimicrobial therapy. Two immunosuppressed patients became infected, one after renal transplantation. Tissue invasion was demonstrated in three patients by the occurrence of a subcutaneous abscess, renal abscesses, and bacteremia, respectively. Aside from the patients no reservoir was shown by culturing personnel, catheter kits, the hospital environment, and the stools and urine of every patient on the ward. Probable spread was by contact through the intermediary of hospital personnel. Control was obtained by having personnel use disposable gloves and contact isolation of patients. The importance of this organism is stressed by the fact that no therapeutic agent was effective in vitro and in vivo.

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