Infections Caused by Providence Bacilli

Abstract

Over an 18-month period 51 patients admitted to the Institut Jules Bordet had providence bacilli isolated from urine, sputum, wounds or stools. In a few patients the bacteria were isolated from multiple sites. 44 patients had been admitted to the neurosurgical intensive care unit and most of them underwent craniotomy; the 7 other patients had metastatic cancer or acute leukemia. Hospitalization was protracted for all patients (mean duration in hospital 54.2 days). Providence bacilli isolates usually appeared late during the hospitalization. Indwelling bladder catheters, tracheostomies and therapy with corticosteroids as well as systemic and/or local antibiotics were commonly encountered. In 10 patients the isolation of providence was not associated with signs of infection and these patients survived without antimicrobial therapy. In the 41 others, true infection took place and septicemia was documented in 4. The septicemic patients died as well as 3 others with bronchopneumonia. Co-trimoxazole and the combination cephalothin/gentamicin appeared effective in vitro against most providence strains isolated. Therapy with these drug combinations was usually successful. Although the nosocomial origin of the providence bacilli causing infections in this series seems very likely, no precise source for the microorganisms could be found in the hospital environment, nor a specific vehicle responsible for cross-infection.