Morganella sp.

In the late 1930s, M morganii was identified as a cause

of urinary tract infections.
In 1984, McDermott reported 19 episodes of M
morganii bacteremia in 18 patients during a 5.5-year
period at a Veterans Administration hospital.[2] Eleven
of the episodes occurred in surgical patients. The most
common source of bacteremia was postoperative wound
infection, and most infections occurred in patients who
had received recent therapy with a beta-lactam
antibiotic.
In 2011, Kwon et al reported a case of a 65-year-old man
with an infected aortic aneurysm in which the pathogen
was M morganii

 Snakebites: M morganii is commonly found in

the mouths of snakes. As a result, it is one of the
organisms recovered most often from snakebite
infections.

 small oxidase-negative
catalase and indole-positive
gram-negative rods
Ferments:
- glucose - mannose
M morganii is motile, facultative anaerobic, and noncapsulated, and it hydrolyzes urease and reduces
nitrates.
Unlike Proteus species, swarming does not occur.

Currently, Morganella contains only a single

species, M morganii, with 2 subspecies, morganii and
sibonii. M morganii was previously classified under
the genus Proteus as Proteus morganii.

Morganella morganii is a gram-negative rod

commonly found in the environment and in the
intestinal tracts of humans, mammals, and
reptiles as normal flora

PATHOPHYSIOLOGY

UTI
Sepsis
Pneumonia
Wound infections
Musculoskeletal infections
CNS infections
Pericarditis

Like Proteus species, M morganii has properties that

Spontaneous bacterial peritonitis
enhance its ability to infect the urinary tract; these include
Endophthalmitis
motility and the ability to produce urease
Empyema
Chorioamnionitis
Neonatal infections

EPIDEMIOLOGY
Frequency
United States
M morganii is a rare cause of severe invasive disease. It
accounts for less than 1% of nosocomial infections. M
morganii is usually opportunistic pathogen in hospitalized
patients, particularly those on antibiotic therapy.

Laboratory Studies

Positive:
-Urease
-Methyl Red
-Ornithine Decarboxylase
-Phenylalanine deaminase
-Gas from D-glucose
KCN growth

RESISTANCE AND SUSCEPTIBILITY

resistant to:
penicillin, ampicillin, ampicillin/sulbactam, oxacillin, firstgeneration
and
second-generation
cephalosporins,
erythromycin, tigecycline, colistin, and polymyxin B.
naturally susceptible to:
piperacillin, ticarcillin, mezlocillin, third-generation and
fourth-generation cephalosporins, carbapenems, aztreonam,
fluoroquinolones, aminoglycosides, and chloramphenicol.

These -lactamases are typically inducible in the presence of

-lactam antibiotics (10), with only trace amounts being
produced in the absence of antibiotics. In the presence of
enzyme-inducing antibiotics these enzymes may lead to
expression of high-level resistance

A second mechanism of -lactam resistance in Morganella

is the chromosomally mediated hyperproduction of lactamases. These strains have mutations at the ampD locus
leading to stable derepression of the -lactamase gene and
permanent production of excessive enzyme levels.

TREATMENT
Initiate treatment with an
extended-spectrum antipseudomonal cephalosporin or
penicillin combined with an aminoglycoside.
Preferred beta-lactam antibiotics include:
cefepime,
ceftazidime,
aztreonam,
piperacillin, and
piperacillin-tazobactam. Carbapenems (ie, imipenem,
meropenem) and
intravenous fluoroquinolones are reserved for resistant
cases.