Over two thirds of Americans live with pets and consider them important members of the family. Pets benefit human health (zooeyia) in 4 ways: as builders of social capital, as agents of harm reduction, as motivators for healthy behavior change, and as potential participants in treatment plans. Conversely, pets can present risks to their owners. They are potential sources of zoonotic disease and injury. Pets can also challenge a family's prioritization of financial and social resources. To activate the benefits of zooeyia and appropriately calibrate and mitigate zoonotic risk, physicians first need to know about the pets in their patients' families. Asking about pets is a simple and feasible approach to assess patients' environmental history and social capital. Asking about pets is a nonthreatening way to build rapport and demonstrates an interest in the whole family, which can improve the physician-patient therapeutic alliance. Physicians can use an interprofessional, collaborative approach with veterinarians to address zoonotic health risks and leverage zooeyia. (J Am Board Fam Med 2015;28:526 -534.)

, five patients in the cardiac surgery unit of the Bristol Royal Infirmary developed septicemia caused by Morganella morganii, Proteus mirabilis, or both of these species. Three of the patients had serious wound infections, and three of the patients died. Typing of the M. morganii isolates by 0serotyping and of the P. mirabilis isolates by 0-serotyping, proticine production and sensitivity, and the Dienes reaction confirmed cross infection by both species. Although M. morganii has been regarded as a relatively unimportant human pathogen in the past, it may prove to be an important cause of nosocomial infection in the future.

The clinical significance of Proteus penneri, a newly described species, is unknown. A case report is presented, which is to the best of our knowledge the first description of this organism causing a urinary tract infection and bladder calculi. Recent revisions in the classification of the Proteeae, a tribe of bacteria belonging to the family Enterobacteriaceae, recognized three genera, namely, Proteus, Providencia, and Morganella (3). In the genus Proteus, three species were identified. These included the well-known P. vulgaris and P. mirabilis species. A third, P. myxofaciens, was proposed for an organism isolated from gypsy moth larvae (Porthetria dispar), but is not of clinical importance. Bacteria formerly in the genus Proteus and previously classified as Proteus rettgeri and Proteus morganii were reassigned to the genera Providencia and Morganella, respectively. Subsequent studies of 20 indole-negative strains generally grouped with P. vulgaris led to the finding that they constituted a separate species (8). The name given to this species was Proteus penneri (10). Although strains of this species have been reported to be isolated from urine, stool, and blood specimens, their clinical significance is largely unknown (8). With the report of this new species, more attention was given to the precise classification of the Proteus species in our laboratory. This species may be differentiated by tests for esculin hydrolysis, salicin, and indole (all negative at 48 h) which are readily performed in clinical laboratories. This

Six cephalosporins and three aminoglycosides were examined for activity against 1,693 isolates belonging to six species of Proteeae. The most notable species-specific differences included the marked susceptibility of Providencia alcalifaciens and Proteus mirabilis to cephalothin, the resistance of Proteus vulgaris to cefamandole, and the resistance of Providencia stuartii to gentamicin and tobramycin. The third-generation cephalosporins cefotaxime and moxalactam were substantially more inhibitory than were cefoperazone, cefamandole, and cefoxitin. P. stuartii, generally the most resistant species, was, however, markedly susceptible to moxalactam and cefotaxime.

Providencia stuartii has emerged as a significant nosocomial urinary tract pathogen. An increase in the number of Providencia isolates from urine cultures prompted an investigation into the possibility of an outbreak due to this organism. A high proportion of patients studied had urinary devices. Four wards were screened at two time periods to ascertain the prevalence of Providencia stuartii in urine cultures. Biotype, serotype, antibiogram and plasmid content were determined for each Providencia isolate. Of 129 patients initially sampled 22.5% were found to harbor Providencia stuartii. Biotyping, serotyping and antibiograms indicated an epidemic strain was not present. Similar results were obtained when the wards were screened a second time, with 25.4% of urine cultures found to contain Providencia stuartii. By plasmid analysis the isolates could be grouped into one of ten profiles. A correlation could be made between urease activity and the presence of a large plasmid. No association however could be made between a particular plasmid profile and antibiogram. The data indicate that an epidemic strain of Providencia stuartii was not present. The source(s) of the endemic Providencia stuartii strains remain unknown.

A prospective survey offecal, urinary tract, and environmental colonization by Providencia stuartii in two wards was undertaken over a 5-month period. Eight of 53 male patients and 2 of 89 female patients were colonized with the endemic serotype 0:63. Two patterns of colonization were found on the male ward. Two patients had persistent urinary tract colonization with no detectable fecal carriage. The other patients had fecal carriage, in some cases persistent, with intermittent urinary tract colonization. The ward environment was in general not contaminated. This study demonstrates that fecal colonization of patients by P. stuartii may be an important and previously underestimated nosocomial reservoir.

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