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M. morganii

Emery Haley, PhD, Scientific Writing Specialist

Morganella morganii

Clinical Summary

  • M. morganii is recognized as a classical, urease-positive, gram-negative, biofilm-forming, motile uropathogen.
  • M. morganii is primarily associated with complicated UTIs in children and older adults with risk-factors such as immunocompromising comorbidities and urinary tract abnormalities.
  • In symptomatic UTI patients, M. morganii:
    • Is not a contaminant (is found in catheter-collected urine specimens).
    • Is viable (can grow out on culture).
    • Is pathogenic (associated with elevated urine biomarkers of infection).
  • Reported severe complications of M. morganii UTI include pyelonephritis, bacteremia, urosepsis, and death.
  • Multidrug-resistant M. morganii is a significant global health threat.

Bacterial Characteristics

Gram-stain

Gram-negative

Morphology

Bacillus

Growth Requirements

Non-fastidious (grows well in standard urine culture conditions)
Facultative anaerobe 

Nitrate Reduction

Yes

Urease

Positive

Biofilm Formation

Yes

Pathogenicity

Colonizer or Pathobiont

Clinical Relevance in UTI

M. morganii is a urease-positive,[1]gram-negative, biofilm-forming, motile bacillus classically recognized as a uropathogen.[2] M. morganii is associated with both community -acquired and hospital-acquired complicated UTIs,[3] primarily among older adults [4]  and children[5,6] with immune-compromising comorbidities and/or urinary tract abnormalities.

In preclinical studies, M. morganii was shown to exhibit synergism with Enterococcus species for biofilm formation.[7]  In contrast, the presence of M. morganii decreased the urease activity, catheter encrustation, and cytotoxicity of P. mirabilis.[7,8]

In a study of older adult males and females with clinically suspected complicated UTI, M. morganii was detected in both midstream voided and in-and-out-catheter collected specimens indicating that it was truly present in the bladder, not simply a contaminant picked up during voiding.[9]  Furthermore, elevated markers of immune system activation in the urinary tract have been measured from the same clinical urine specimens in which M. morganii was detected, indicating that the presence of M. morganii was associated with an immune response to urinary tract infection.[10–12]  ​

Although not considered one of the six highest priority “ESKAPE” pathogens, The World Health Organization (WHO) has included this organism in the 2024 Bacterial Priority Pathogens List (BPPL).[13] Severe reported complications of M. morganii UTI include pyelonephritis, bacteremia, urosepsis, and death.[4,6,14]

Together, these findings indicate that M. morganii should be seriously considered as a uropathogen and demonstrate the value of detecting this organism, particularly in individuals with urinary tract abnormalities, immunocompromise, or other risk factors for complicated UTI.

Treatment

Evidence of Efficacy (Checkmarks): Ampicillin/Sulbactam, Cefepime, Cephalexin, Ciprofloxacin, Doxycycline, Gentamicin, Levofloxacin, Meropenem, Piperacillin/Tazobactam, Sulfamethoxazole/Trimethoprim, and Trimethoprim.

References

  1. BacDive | The Bacterial Diversity Metadatabase Available online: https://bacdive.dsmz.de/ (accessed on 11 February 2025).
  2. Minnullina, L.; Kostennikova, Z.; Evtugin, V.; Akosah, Y.; Sharipova, M.; Mardanova, A. Diversity in the Swimming Motility and Flagellar Regulon Structure of Uropathogenic Morganella Morganii Strains. Int. Microbiol. 2022, 25, 111–122, doi:10.1007/s10123-021-00197-7.
  3. Silva, L.C.; Sanches, M.S.; Guidone, G.H.M.; Montini, V.H.; Oliva, B.H.D. de; Nascimento, A.B. do; Galhardi, L.C.F.; Kobayashi, R.K.T.; Vespero, E.C.; Rocha, S.P.D. Clonal Relationship, Virulence Genes, and Antimicrobial Resistance of Morganella Morganii Isolated from Community-Acquired Infections and Hospitalized Patients: A Neglected Opportunistic Pathogen. Int. Microbiol. 2024, 27, 411–422, doi:10.1007/s10123-023-00400-x.
  4. Karlbom, O.; Sunnerhagen, T.; Ljungquist, O. Morganella Morganii Bloodstream Infection Affects the Elderly in Close Contact with Health Care. IJID Reg. 2024, 13, 100480, doi:10.1016/j.ijregi.2024.100480.
  5. Atmış, B.; Kara, S.S.; Aslan, M.H. Community-Acquired Pediatric Urinary Tract Infections Caused by Morganella Morganii. J. Pediatr. Res. 2020, 7, 121–125, doi:10.4274/jpr.galenos.2019.35582.
  6. Shi, H.; Chen, X.; Yao, Y.; Xu, J. Morganella Morganii: An Unusual Analysis of 11 Cases of Pediatric Urinary Tract Infections. J. Clin. Lab. Anal. 2022, 36, e24399, doi:10.1002/jcla.24399.
  7. Gaston, J.R.; Johnson, A.O.; Bair, K.L.; White, A.N.; Armbruster, C.E. Polymicrobial Interactions in the Urinary Tract: Is the Enemy of My Enemy My Friend? Infect Immun 2021, 89, doi:10.1128/iai.00652-20.
  8. Learman, B.S.; Brauer, A.L.; Eaton, K.A.; Armbruster, C.E. A Rare Opportunist, Morganella Morganii, Decreases Severity of Polymicrobial Catheter-Associated Urinary Tract Infection. Infect Immun 2019, 88, doi:10.1128/iai.00691-19.
  9. Wang, D.; Haley, E.; Luke, N.; Mathur, M.; Festa, R.; Zhao, X.; Anderson, L.A.; Allison, J.L.; Stebbins, K.L.; Diaz, M.J.; et al. Emerging and Fastidious Uropathogens Were Detected by M-PCR with Similar Prevalence and Cell Density in Catheter and Midstream Voided Urine Indicating the Importance of These Microbes in Causing UTIs. Infect. Drug Resist. 2023, Volume 16, 7775–7795, doi:10.2147/idr.s429990.
  10. Haley, E.; Luke, N.; Mathur, M.; Festa, R.A.; Wang, J.; Jiang, Y.; Anderson, L.A.; Baunoch, D. The Prevalence and Association of Different Uropathogens Detected by M-PCR with Infection-Associated Urine Biomarkers in Urinary Tract Infections. Res. Rep. Urol. 2024, 16, 19–29, doi:10.2147/rru.s443361.
  11. Akhlaghpour, M.; Haley, E.; Parnell, L.; Luke, N.; Mathur, M.; Festa, R.A.; Percaccio, M.; Magallon, J.; Remedios-Chan, M.; Rosas, A.; et al. Urine Biomarkers Individually and as a Consensus Model Show High Sensitivity and      Specificity for Detecting UTIs. BMC Infect Dis 2024, 24, 153, doi:10.1186/s12879-024-09044-2.
  12. Parnell, L.K.D.; Luke, N.; Mathur, M.; Festa, R.A.; Haley, E.; Wang, J.; Jiang, Y.; Anderson, L.; Baunoch, D. Elevated UTI Biomarkers in Symptomatic Patients with Urine Microbial Densities of 10,000 CFU/ML Indicate a Lower Threshold for Diagnosing UTIs. MDPI 2023, 13, 1–15, doi:10.3390/diagnostics13162688.
  13. 2024 WHO Bacterial Priority Pathogens List (WHO BPPL) Available online: https://iris.who.int/bitstream/handle/10665/376776/9789240093461-eng.pdf?sequence=1 (accessed on 18 March 2025).
  14. Puri, S.; Meshram, H.S.; Bhagat, C.; Mathur, R.P.; Thakur, A.N. Morganella Morganii Graft Pyelonephritis in a Kidney Transplant Recipient: A Rare Case Report in a Failing Allograft. Indian J. Transplant. 2024, 18, 483–484, doi:10.4103/ijot.ijot_26_24.

About the Author

Dr. Emery Haley is a scientific writing specialist with over ten years of experience in translational cell and molecular biology. As both a former laboratory scientist and an experienced science communicator, Dr. Haley is passionate about making complex research clear, approachable, and relevant. Their work has been published in over 10 papers and focuses on bridging the gap between the lab and real-world patient care to help drive better health outcomes.

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