Providencia infection is most commonly encountered as a catheter-associated urinary tract infection in elderly patients residing in nursing homes. Typical symptoms of dysuria, polyuria, and fever are noticed. Having in mind the resistance to many antimicrobial agents by Providencia spp. which may lead to rapid clinical deterioration due to improper therapy, an early diagnosis is vital. Urinalysis and urine cultures are crucial for identifying the causative bacteria.
Initially described as a subgroup of Proteus spp., Providencia spp. are ubiquitously present (water, soil, and various animals are known reservoirs) opportunistic gram-negative bacilli belonging to the large group of Enterobacteriaceae and six types have been described in the literature (P. rettgeri, P. stuartii, P. alcalifaciens, P. rustigianii, and P. heimbachae)  . P. rettgeri and P. stuartii are the two most important species that are considered primarily as causative agents of catheter-associated urinary tract infections (CA-UTI) in humans     . By possessing urease, an enzyme that breaks down urea into carbon dioxide and ammonia, Providencia promotes acidification of urine, bacteremia, and the formation of urolithiasis, which may be particularly troubling in cases with long-standing indwelling urinary catheters where biofilms could be formed   . In fact, the majority of patients are elderly individuals residing in nursing homes    . The clinical presentation of UTI is marked dysuria, polyuria, and sometimes fever or chills, but a very wide spectrum of symptoms can be observed, ranging from minimal findings to severe and life-threatening urosepsis . In addition to UTIs, frequently being polymicrobial in nature, the bacteria were identified in cases of meningitis, endocarditis, gastrointestinal disorders manifesting with diarrhea, abdominal pain, and vomiting, as well as ocular ailments and endocarditis   .
Because of the rare occurrence of this medical entity in clinical practice (isolated studies report an incidence rate of 3.4 infections per 100,000 people per year), the diagnosis may be difficult to attain  . For this reason, a meticulous workup must be performed, as mortality rates of Providencia infections are shown to be high without the proper therapy (the main reason being a broad range of antimicrobial resistance)  . The physician must assess the presence of risk factors for a UTI (eg. older age, indwelling catheters) when evaluating patients with suggestive signs, whereas residence in nursing homes can further raise suspicion to a less typical causative agent. When a presumptive diagnosis is made, urinalysis (typically showing pyuria) and urine cultures (the gold standard for confirming UTI) must be drawn as soon as possible, in order to determine the etiologic pathogen and the profile of antimicrobial resistance . Detection of more than one microbe on urine cultures in addition to Providencia is not uncommon   .