Abstract
Proteus spp. are members of the Enterobacteriaceae family and are Gram-negative, rod-shaped bacteria known to mainly cause urinary tract infections (UTIs) in humans. However, even though scarce evidence exists suggesting their potential to cause infective endocarditis (IE), a study summarizing the existing evidence is lacking. The purpose of this study was to systemically review all published cases of IE by Proteus species in the literature. A systematic review of PubMed, Scopus and Cochrane Library (through 5(th) May 2020) for studies providing epidemiological, clinical and microbiological data as well as data on treatment and outcomes of IE by Proteus species was performed. A total of 16 studies, containing data of 16 patients, were included. A prosthetic valve was present in 25%, while the most common causative pathogen was P. mirabilis. Aortic valve was the most common infected site in 33.3%, followed by mitral valve in 26.7%. Diagnosis was set with transesophageal echocardiography in 37.5%, and transthoracic echocardiography in 25%, while the diagnosis was set at autopsy in 25%. Fever and sepsis were present in 100% and 84.6%, respectively. Aminoglycosides and cephalosporins were the most common antimicrobials used for treatment. Clinical cure was noted in 62.5%, while overall mortality was 43.8%. This systematic review describes IE by Proteus species in detail and provides information on epidemiology, clinical presentation, treatment and outcomes.