Proteus mirabilis Skin and Soft Tissue Infection
Proteus mirabilis can cause skin and soft tissue infections, including cellulitis, although it is not a typical skin pathogen. [1] Published clinical reports describe P. mirabilis isolated from wounds or cellulitis-like presentations. [1]
Clinical Evidence Supporting Causation
A case report described an atypical manifestation of cellulitis in which wound cultures later grew P. mirabilis. [1] In randomized clinical trial populations of infections of the skin and superficial soft tissue, P. mirabilis was among the reported causative organisms. [2] In a double-blind study of infections of skin and skin structure that included cellulitis, P. mirabilis was among the pathogens identified in bacteriologically documented infections. [3]
Predisposing Contexts in Reported Cases
P. mirabilis cellulitis-like disease has been reported in association with local skin trauma and underlying comorbid illness. [1] In trial data, these infections were frequently polymicrobial, which supports a role for P. mirabilis in mixed skin and soft tissue infections rather than as a classic monomicrobial cellulitis organism. [2]
Monomicrobial Versus Polymicrobial Pattern
P. mirabilis involvement in skin and soft tissue infections occurs in the context of infections that may include other aerobic and anaerobic organisms. [2] P. mirabilis has been reported among pathogens in mixed infections in skin and soft tissue infection trials. [3]
Practical Clinical Implication for Workup
Culture-directed management is supported in cases where empiric therapy fails or where an unusual organism is suspected. [1] When cultures document P. mirabilis, antibiotic selection should be adjusted to organism susceptibility and clinical response monitoring should continue. [1]
Limitations of Typical Etiology Attribution
Standard cellulitis is typically attributed to other organisms such as streptococci and staphylococci, and P. mirabilis is described as infrequent in this role. [1] Evidence for P. mirabilis causing cellulitis is therefore strongest when supported by culture or bacteriologic documentation in the specific case. [1]
Treatment Considerations
P. mirabilis cellulitis-like infection has resolved after antibiotic adjustment guided by culture results in a reported case. [1] In randomized studies of skin and superficial soft tissue infections, clinical response rates were reported in treated cohorts where P. mirabilis occurred among the identified pathogens. [2] [3]