1
|
Sahuquillo-Arce J, Suárez-Urquiza P, Hernández-Cabezas A, Tofan L, Chouman-Arcas R, García-Hita M, Sabalza-Baztán O, Sellés-Sánchez A, Lozano-Rodríguez N, Martí-Cuñat J, López-Hontangas J. Actinotignum schaalii infection: Challenges in diagnosis and treatment. Heliyon 2024; 10:e28589. [PMID: 38590897 PMCID: PMC10999919 DOI: 10.1016/j.heliyon.2024.e28589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Actinotignum schaalii affects elderly people and is associated with individuals with urological-related predispositions, but can be found in a variety of locations, such as cutaneous, intraabdominal, genitourinary and surgical infections. Disseminated infections occur less frequently and are by and large related to urinary tract colonisation. This pathogen is often neglected due to growth requirements, especially in urinary tract infections. We present 107 Actinotignum schaalii isolated from genitourinary samples (80.4%), from skin and soft tissue infections (13.1%), from bone and deep tissue infection (4.7%) and from blood cultures (1.9%). The automated system Alfred 60/AST was paramount for the isolation of 77.6% of the UTI. All the isolates tested were susceptible to penicillin, ampicillin, linezolid, vancomycin, teicoplanin, rifampicin and tetracycline. In conclusion, we present a large series of Actinotignum schaalii infections. This pathogen is hard to isolate, and is resistant to commonly used empirical antimicrobials.
Collapse
Affiliation(s)
- J.M. Sahuquillo-Arce
- Servicio de Microbiología, Hospital Doctor Moliner, Serra, Spain
- Grupo de Investigación de Infecciones Respiratorias, IIS La Fe, Valencia, Spain
| | - P. Suárez-Urquiza
- Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A. Hernández-Cabezas
- Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - L. Tofan
- Servicio de Análisis Clínicos, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - R. Chouman-Arcas
- Servicio de Microbiología, Hospital Francesc de Borja, Gandia, Spain
| | - M. García-Hita
- Servicio de Microbiología, Hospital de la Vega Lorenzo Guirao, Cieza, Spain
| | - O. Sabalza-Baztán
- Servicio de Microbiología, Hospital General Universitari de Castelló, Castellón de la Plana, Spain
| | | | - N. Lozano-Rodríguez
- Servicio de Microbiología, Hospital General Universitari de Castelló, Castellón de la Plana, Spain
| | - J. Martí-Cuñat
- Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J.L. López-Hontangas
- Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
2
|
Li S, Ma C, Yang Y, Cai W, Dai W, Zhang X, Yin L, Tang D, Liu F, Dai Y. Microbiome and metabolome analysis to clarify the interaction between the urine microbiota and serum metabolites in Chinese patients with immunoglobulin A nephropathy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1230. [PMID: 36544661 PMCID: PMC9761118 DOI: 10.21037/atm-22-5334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Background The bacterial and metabolic networks in immunoglobin A nephropathy (IgAN), the most common type of primary chronic glomerulonephritis worldwide, have not been extensively studied. To help develop better methods for the diagnosis, treatment, and prognosis of IgAN, we characterized the alterations of the urinary microbiome and serum metabolome in patients with IgAN. Methods We analyzed serum and urine samples from Chinese patients with IgAN and healthy controls (HCs) using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and 16S ribosomal RNA gene sequencing. Results Patients with IgAN had a higher relative abundance of Actinomyces and a lower relative abundance of Lactobacillus. The elements of metabolism have been affected, including free amino acids, polyunsaturated fatty acids, and oligopeptides. We also identified the 9 metabolites that might be the core metabolites, including guanidinoacetic acid, apo-[3-methylcrotonoyl-CoA:carbon-dioxide ligase (ADP-forming)], and diethanolamine, which linked the metabolic networks between the urinary tract (UT) and blood. Other core metabolites, such as homocitrulline, apo-[3-methylcrotonoyl-CoA:carbon-dioxide ligase (ADP-forming)], butyrylcarnitine, formiminoglutamic acid (FIGLU), diethanolamine, and prolylhydroxyproline, were positively correlated with urinary mili-total protein (MTP). Conversely, Lactobacillus was negatively correlated with MTP. Conclusions We verified the connection between the disruption of the microbiota and serum metabolites, along with the clinical parameters, in patients with IgAN, which may help provide a tool for IgAN interventions.
Collapse
Affiliation(s)
- Shishi Li
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China;,Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Chiyu Ma
- Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Yan Yang
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wanxia Cai
- Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Weier Dai
- College of Natural Science, The University of Texas at Austin, Austin, TX, USA
| | - Xinzhou Zhang
- Department of Nephrology, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Lianghong Yin
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Donge Tang
- Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Fanna Liu
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yong Dai
- Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, Shenzhen, China
| |
Collapse
|
3
|
Ioannou P, Karakonstantis S, Tavlas E, Kontopodis N, Maraki S, Chamilos G, Kofteridis DP. Actinotignum schaalii infection - a case series from a tertiary hospital in Greece. Germs 2022; 12:394-399. [PMID: 37680677 PMCID: PMC10482473 DOI: 10.18683/germs.2022.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 09/09/2023]
Abstract
Introduction Actinotignum schaalii is a small Gram-positive facultative anaerobic coccoid rod that was reclassified in 1997 from the genus Actinomyces and is difficult to culture with usual microbiological techniques, as it is slowly growing. A. schaalii is an emerging human pathogen that is most commonly implicated in urinary tract infections (UTIs), but has also been isolated less frequently from abscesses of various sites (such as the skin, the genitourinary tract, surgical sites or intraabdominal). Methods All cases where A. schaalii was identified during a 6-year period (January 2016 - January 2022) in the University Hospital of Heraklion were reviewed. Results A. schaalii was isolated in 11 cultures from 10 patients. The site of infection was skin and soft tissue in nine out of eleven cultures (81.8%) and the bone was the site of infection in two patients (18.2%). Most cultures were polymicrobial. The median age of patients was 55.5 years (interquartile range 34-63 years), and 80% (n=8) were male. A. schaalii was susceptible to beta-lactams, quinolones and vancomycin, but resistant to clindamycin, erythromycin and metronidazole. Moreover, two cases of diabetic patients diagnosed with polymicrobial diabetic foot osteomyelitis from this organism are presented in detail. Both patients were successfully managed with targeted antimicrobial treatment and prompt surgical management. Conclusions A. schaalii is an emerging pathogen that is likely under-reported due to difficulties in isolation and identification. Herein two cases of diabetic foot osteomyelitis are also presented in detail, successfully managed with targeted antimicrobial therapy and surgical debridement.
Collapse
Affiliation(s)
- Petros Ioannou
- MD, MSc, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Stamatis Karakonstantis
- MD, MSc, Department of Vascular Diseases, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Emmanuil Tavlas
- MD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Nikolaos Kontopodis
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Sofia Maraki
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - George Chamilos
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Diamantis P Kofteridis
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| |
Collapse
|
4
|
A 2-Year Retrospective Case Series on Isolates of the Emerging Pathogen Actinotignum schaalii from a Canadian Tertiary Care Hospital. Microorganisms 2022; 10:microorganisms10081608. [PMID: 36014029 PMCID: PMC9412865 DOI: 10.3390/microorganisms10081608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/21/2022] Open
Abstract
(1) Background: Actinotignum schaalii is an emerging, opportunistic pathogen often linked with UTIs but can extend beyond the urogenital system. Data on the clinical significance of A. schaalii are still emerging. (2) Methods: A retrospective review of A. schaalii isolates in a Canadian tertiary care hospital was conducted. The clinical data of patients that grew A. schaalii from January 2020 to 2022 were documented. Demographics, site, management, and microbiological parameters surrounding culture and sensitivities were recorded. (3) Results: A total of 43 cases of A. schaalii were identified. Actinotignum schaalii was primarily involved in UTIs (n = 17), abscesses (n = 9), bacteremia (n = 6), septic arthritis (n = 5), and ulcers (n = 5). A. schaalii had a slight predilection for polymicrobial infections (51.1%, n = 22 out of 43), with Aerococcus urinae (n = 5) being the most common coisolate. Susceptibility testing was only performed in two cases that showed sensitivity to beta-lactam antibiotics and resistance to metronidazole and ciprofloxacin. Amoxicillin–clavulanate (n = 5) is the most frequently prescribed antibiotic. (4) Conclusions: The non-urogenic clinical significance of A. schaalii remains undervalued. The management of A. schaalii infection is multimodal, consisting predominantly of antimicrobials and surgical procedures specific to the etiology. Clinicians should request sensitivities for A. schaalii so that appropriate antimicrobial coverage can be provided.
Collapse
|
5
|
Clinical characteristics of Actinotignum schaalii bacteremia in a Japanese tertiary hospital. Anaerobe 2022; 77:102513. [DOI: 10.1016/j.anaerobe.2022.102513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 11/18/2022]
|
6
|
Kotásková I, Syrovátka V, Obručová H, Vídeňská P, Zwinsová B, Holá V, Blaštíková E, Růžička F, Freiberger T. Actinotignum schaalii: Relation to Concomitants and Connection to Patients' Conditions in Polymicrobial Biofilms of Urinary Tract Catheters and Urines. Microorganisms 2021; 9:microorganisms9030669. [PMID: 33807120 PMCID: PMC8004716 DOI: 10.3390/microorganisms9030669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/30/2022] Open
Abstract
Actinotignum schaalii is an emerging, opportunistic pathogen and its connection to non-infectious diseases and conditions, such as prostate or bladder cancer, or chronic inflammation has been proposed. Here, we analyzed 297 urine, ureteral and urinary catheter samples from 128 patients by Polymerase Chain Reaction followed by Denaturing Gradient Gel Electrophoresis and Sequencing (PCR-DGGE-S), and culture, and 29 of these samples also by 16S rRNA Illumina sequencing, to establish A. schaalii’s prevalence in urinary tract-related samples, its relation to other bacteria, and its potential association with patients’ conditions and samples’ characteristics. A. schaalii-positive samples were significantly more diverse than A. schaalii negative and between-group diversity was higher than intra-group. Propionimicrobium lymphophilum, Fusobacterium nucleatum, Veillonella sp., Morganella sp., and Aerococcus sp. were significantly more often present in A. schaalii-positive samples; thus, we suggest these species are A. schaalii’s concomitants, while Enterobacter and Staphylococcaceae were more often identified in A. schaalii-negative samples; therefore, we propose A. schaalii and these species are mutually exclusive. Additionally, a significantly higher A. schaalii prevalence in patients with ureter stricture associated hydronephrosis (p = 0.020) was noted. We suggest that A. schaalii could be an early polybacterial biofilm colonizer, together with concomitant species, known for pro-inflammatory features.
Collapse
Affiliation(s)
- Iva Kotásková
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, 61600 Brno, Czech Republic; (I.K.); (H.O.); (E.B.)
- Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, 61600 Brno, Czech Republic
- Research Centre for Toxic Compounds in the Environment, Masaryk University, 61600 Brno, Czech Republic; (P.V.); (B.Z.)
| | - Vít Syrovátka
- Department of Botany and Zoology, Faculty of Science, Masaryk University, 61600 Brno, Czech Republic;
| | - Hana Obručová
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, 61600 Brno, Czech Republic; (I.K.); (H.O.); (E.B.)
| | - Petra Vídeňská
- Research Centre for Toxic Compounds in the Environment, Masaryk University, 61600 Brno, Czech Republic; (P.V.); (B.Z.)
| | - Barbora Zwinsová
- Research Centre for Toxic Compounds in the Environment, Masaryk University, 61600 Brno, Czech Republic; (P.V.); (B.Z.)
| | - Veronika Holá
- Institute of Microbiology, Faculty of Medicine, St. Anne’s University Hospital, Masaryk University, 61600 Brno, Czech Republic; (V.H.); (F.R.)
| | - Eva Blaštíková
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, 61600 Brno, Czech Republic; (I.K.); (H.O.); (E.B.)
| | - Filip Růžička
- Institute of Microbiology, Faculty of Medicine, St. Anne’s University Hospital, Masaryk University, 61600 Brno, Czech Republic; (V.H.); (F.R.)
| | - Tomáš Freiberger
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, 61600 Brno, Czech Republic; (I.K.); (H.O.); (E.B.)
- Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, 61600 Brno, Czech Republic
- Correspondence:
| |
Collapse
|
7
|
Barberis C, Ledesma M, Álvarez C, Famiglietti A, Almuzara M, Vay C. [Analysis of the diversity of Actinomyces/Actinotignum clinical isolates in a university hospital]. Rev Argent Microbiol 2021; 53:202-209. [PMID: 33402284 DOI: 10.1016/j.ram.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/22/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022] Open
Abstract
Actinomyces and related genera are grampositive bacilli, opportunistic pathogens, which have been mainly involved in endogenous infections. However, due to the complexity in identifying them for most clinical laboratories, there is scant knowledge about their real clinical significance. In this work, 166 isolates of 13 different species of Actinomyces/Actinotignum species recovered from clinical samples of patients treated in a university hospital were studied. The identification was performed by MALDI-TOF MS and molecular identification. MALDI-TOF MS identified 91.57% of the isolates (152/166) at the species level using a score ≥ 1.7 and 3.61% (6/166) of the isolates were identified only at the gender level with a score ≥ 1.5. MALDI-TOF MS did not yield reliable identification results for 4.82% (8/166) of the isolates. Actinomyces/Actinotignum species were isolated from: soft tissue (n: 47), urine samples (n: 35), head / neck abscesses (n: 19), genital abscesses (n: 11), blood samples (n: 10), breast abscesses (n: 8), osteoarticular samples (n: 6), abdominal/ascitic fluids (n: 3), abdominal abscesses (n: 5), sputum/BAL (n: 4), brain abscesses (n: 3), and others (n: 15). The results obtained from the statistical analysis showed a high differential frequency (> 2) for the location/species association: urine/A. schaalii/sanguinis; brain abscesses/A. europaeus; osteoarticular samples/A. urogenitalis; abdominal abscesses/ A. turicensis; respiratory samples/A. naeslundii/viscosus. This information provides a greater understanding of the clinical and epidemiological relevance of these species. The pathogenic role of Actinomyces spp. will be increasingly revealed as these microorganisms could be recognized thanks to prolonged culture and the advances in identification technology facilitated by MALDI-TOF MS.
Collapse
Affiliation(s)
- Claudia Barberis
- Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Hospital de Clínicas «José de San Martín», Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Martín Ledesma
- Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Hospital de Clínicas «José de San Martín», Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carla Álvarez
- Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Hospital de Clínicas «José de San Martín», Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Angela Famiglietti
- Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Hospital de Clínicas «José de San Martín», Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marisa Almuzara
- Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Hospital de Clínicas «José de San Martín», Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos Vay
- Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Hospital de Clínicas «José de San Martín», Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
8
|
Actinobaculum massiliense Proteome Profiled in Polymicrobial Urethral Catheter Biofilms. Proteomes 2018; 6:proteomes6040052. [PMID: 30544882 PMCID: PMC6314084 DOI: 10.3390/proteomes6040052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 01/28/2023] Open
Abstract
Actinobaculum massiliense, a Gram-positive anaerobic coccoid rod colonizing the human urinary tract, belongs to the taxonomic class of Actinobacteria. We identified A. massiliense as a cohabitant of urethral catheter biofilms (CB). The CBs also harbored more common uropathogens, such as Proteus mirabilis and Aerococcus urinae, supporting the notion that A. massiliense is adapted to a life style in polymicrobial biofilms. We isolated a clinical strain from a blood agar colony and used 16S rRNA gene sequencing and shotgun proteomics to confirm its identity as A. massiliense. We characterized this species by quantitatively comparing the bacterial proteome derived from in vitro growth with that of four clinical samples. The functional relevance of proteins with emphasis on nutrient import and the response to hostile host conditions, showing evidence of neutrophil infiltration, was analyzed. Two putative subtilisin-like proteases and a heme/oligopeptide transporter were abundant in vivo and are likely important for survival and fitness in the biofilm. Proteins facilitating uptake of xylose/glucuronate and oligopeptides, also highly expressed in vivo, may feed metabolites into mixed acid fermentation and peptidolysis pathways, respectively, to generate energy. A polyketide synthase predicted to generate a secondary metabolite that interacts with either the human host or co-colonizing microbes was also identified. The product of the PKS enzyme may contribute to A. massiliense fitness and persistence in the CBs.
Collapse
|
9
|
Ruiz-García C, Muñoz-Hoyos A, Lara-Oya A, Navarro-Marí JM, Gutiérrez-Fernández J. Actinotignum induced balanopostitis in children. A literature review and a case report. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
10
|
Lainhart W, Yarbrough ML, Jean S, Burnham CAD. New Bugs and New Drugs: Updates in Clinical Microbiology. J Appl Lab Med 2018; 2:925-940. [PMID: 33636835 DOI: 10.1373/jalm.2017.023101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/05/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The landscape of clinical microbiology laboratories is changing. As new technologies are introduced, we are better able to detect and identify pathogens and to recognize and characterize emerging antimicrobial resistance mechanisms. CONTENT In this review, a selected cross-section of current hot topics in clinical microbiology is discussed. These topics include (a) diagnostics for urinary tract and sexually transmitted infections; (b) phenotypic and genotypic methods of detecting carbapenem resistance and discussion of newly approved anti-infective agents for these multi-drug resistant organisms; and (c) the significance, epidemiology, and identification of the emerging pathogens Mycobacterium chimaera and Candida auris. SUMMARY Communication between clinical microbiologists and their clinical colleagues is imperative to convey the significance of emerging pathogens and resistance determinants, as well as the performance characteristics of new diagnostic methods. Additionally, as antimicrobial resistance is surging, it is important to comprehensively evaluate the resistance profiles of clinical isolates to facilitate antimicrobial stewardship and inform infection prevention measures. Although antimicrobial resistance is a global public health crisis, it is encouraging that new anti-infective agents are in the pipeline and being approved for use in patients.
Collapse
Affiliation(s)
- William Lainhart
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Melanie L Yarbrough
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Sophonie Jean
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Carey-Ann D Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
11
|
Ruiz-García C, Muñoz-Hoyos A, Lara-Oya A, Navarro-Marí JM, Gutiérrez-Fernández J. [Actinotignum induced balanopostitis in children. A literature review and a case report]. An Pediatr (Barc) 2017; 89:246-248. [PMID: 29290502 DOI: 10.1016/j.anpedi.2017.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Carlos Ruiz-García
- Unidad de Gestión Clínica de Pediatría y Neonatología, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Antonio Muñoz-Hoyos
- Unidad de Gestión Clínica de Pediatría y Neonatología, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada, Granada, España; Departamento de Pediatría, Facultad de Medicina, Universidad de Granada, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Ana Lara-Oya
- Laboratorio de Microbiología, Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - José María Navarro-Marí
- Laboratorio de Microbiología, Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - José Gutiérrez-Fernández
- Laboratorio de Microbiología, Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, España; Departamento de Microbiología, Facultad de Medicina, Universidad de Granada, Instituto de Investigación Biosanitaria de Granada, Granada, España.
| |
Collapse
|
12
|
Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract. Microbiol Spectr 2017; 4. [PMID: 27227294 DOI: 10.1128/microbiolspec.uti-0012-2012] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Gram-positive bacteria are a common cause of urinary-tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI.
Collapse
|
13
|
Antimicrobial susceptibility of clinical isolates of Actinomyces and related genera reveals an unusual clindamycin resistance among Actinomyces urogenitalis strains. J Glob Antimicrob Resist 2017; 8:115-120. [DOI: 10.1016/j.jgar.2016.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/29/2016] [Accepted: 11/16/2016] [Indexed: 11/23/2022] Open
|
14
|
Clinical and microbiological features of Actinotignum bacteremia: a retrospective observational study of 57 cases. Eur J Clin Microbiol Infect Dis 2016; 36:791-796. [PMID: 27957598 PMCID: PMC5395584 DOI: 10.1007/s10096-016-2862-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/30/2016] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to investigate the incidence, clinical presentation, and prognosis of Actinotignum bacteremia in southern Sweden. Actinotignum isolates in blood cultures were identified retrospectively between 1st January 2012 and 31st March 2016 through searches in the clinical microbiology laboratory database. The population covered by this laboratory is approximately 1.3 million. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used for species determination. Etests were used for minimum inhibitory concentration (MIC) determination. The patients’ medical charts were reviewed. Fifty-eight episodes in fifty-seven patients with Actinotignum bacteremia were identified (A. schaalii = 53, A. sanguinis = 1, A. urinale = 2, and Actinotignum species = 3), which corresponds to an incidence of 11 cases per million inhabitants. Fifty-one percent of the isolates were in pure culture. The MICs were low for β-lactam antibiotics, whereas high MICs were recorded for ciprofloxacin and trimethoprim. Patients had a median age of 82 years, 72% were male, and a majority had underlying urological conditions. Thirty-six of the patients were diagnosed with a focus from the urinary tract. Thirty-one patients developed severe sepsis and nine patients died during the hospital stay. Our study is the largest of Actinotignum bacteremia and demonstrates that it is a condition with a significant fatality that affects elderly persons with underlying conditions. β-Lactams represent a rational treatment option.
Collapse
|
15
|
Vallet A, Noël N, Bahi R, Teicher E, Quertainmont Y, Delfraissy JF, Ferlicot S, Potron A, Goujard C, Lambotte O. Recurrent obstructive acute pyelonephritis: A rare form of Actinotignum (Actinobaculum) schaalii infection in a HIV-1 infected patient. Anaerobe 2016; 43:75-77. [PMID: 27940245 DOI: 10.1016/j.anaerobe.2016.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/01/2016] [Accepted: 12/04/2016] [Indexed: 11/18/2022]
Abstract
Actinobaculum schaalii is a rarely reported, anaerobic, Gram-positive bacterium which role as uropathogen is emerging. We report here the case of a 47 year old HIV-1 infected woman presented with five recurrent episodes of obstructive pyelonephritis in the context of multiple renal stones. No bacteria was found until the fifth episode, during which prolonged urinary cultures as well as 16S rDNA sequencing allowed the diagnosis of A. schaalii infection. She had developed a life-threatening condition with severe renal failure. A right nephrectomy was performed and found that the intrarenal stones were attributed to the antiretroviral therapy. The renal parenchyma corresponded to an end-stage renal disease with chronic pyelonephritis without abcesses or granules. The situation improved after six months of amoxicillin therapy.
Collapse
Affiliation(s)
- Anaïs Vallet
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - Nicolas Noël
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France; Université Paris 11, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, France; Inserm, U1184, Centre d'Immunologie des Maladies Virales et Autoimmunes, France.
| | - Rachid Bahi
- Assistance Publique Hôpitaux de Paris, Service d'Urologie, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - Elina Teicher
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - Yann Quertainmont
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - Jean-François Delfraissy
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France; Université Paris 11, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, France; Inserm, U1184, Centre d'Immunologie des Maladies Virales et Autoimmunes, France
| | - Sophie Ferlicot
- Université Paris 11, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France; Assistance Publique Hôpitaux de Paris, Service d'Anatomie et de Cytologie Pathologiques, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - Anaïs Potron
- Assistance Publique Hôpitaux de Paris, Service de Microbiologie, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
| | - Cécile Goujard
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France; Université Paris 11, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France
| | - Olivier Lambotte
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France; Université Paris 11, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, France; Inserm, U1184, Centre d'Immunologie des Maladies Virales et Autoimmunes, France
| |
Collapse
|
16
|
Maraki S, Evangelou G, Stafylaki D, Scoulica E. Actinotignum schaalii subcutaneous abscesses in a patient with hidradenitis suppurativa: Case report and literature review. Anaerobe 2016; 43:43-46. [PMID: 27913316 DOI: 10.1016/j.anaerobe.2016.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022]
Abstract
Actinotignum schaalii (formerly Actinobaculum schaalii) is a Gram-positive, facultative anaerobic rod that is typically involved in urinary tract infections in elderly patients or those with underlying urological pathologies. In contrast, abscess formation caused by A. schaalii is very rare. We present a case of multiple abscesses in the perineal area in a young patient with hidradenitis suppurativa associated with A. schaalii and Prevotella melaninogenica and review the relevant literature on the topic.
Collapse
Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Crete, Greece.
| | - George Evangelou
- Department of Dermatology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Dimitra Stafylaki
- Department of Clinical Microbiology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Crete, Greece
| | - Efstathia Scoulica
- Laboratory of Clinical Bacteriology and Molecular Microbiology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| |
Collapse
|
17
|
Siller Ruiz M, Hernández Egido S, Calvo Sánchez N, Muñoz Bellido JL. Unusual clinical presentations of Actinotignum (Actinobaculum) schaalii infection. Enferm Infecc Microbiol Clin 2016; 35:197-198. [PMID: 27810121 DOI: 10.1016/j.eimc.2016.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022]
Affiliation(s)
- María Siller Ruiz
- Servicio de Microbiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL-CSIC), Salamanca, Spain
| | - Sara Hernández Egido
- Servicio de Microbiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL-CSIC), Salamanca, Spain
| | - Noelia Calvo Sánchez
- Servicio de Microbiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Juan Luis Muñoz Bellido
- Servicio de Microbiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL-CSIC), Salamanca, Spain; Unidad de Investigación Consolidada de Castilla y León UIC-079, Spain; Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Salamanca, Spain.
| |
Collapse
|
18
|
Clinical Significance of Commensal Gram-Positive Rods Routinely Isolated from Patient Samples. J Clin Microbiol 2016; 54:2928-2936. [PMID: 27629905 DOI: 10.1128/jcm.01393-16] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/09/2016] [Indexed: 12/11/2022] Open
Abstract
Commensal bacteria from the skin and mucosal surfaces are routinely isolated from patient samples and considered contaminants. The majority of these isolates are catalase-positive Gram-positive rods from multiple genera routinely classified as diphtheroids. These organisms can be seen upon Gram staining of clinical specimens or can be isolated as the predominant or pure species in culture, raising a priori suspicion of a possible involvement in infection. With the development and adoption of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), suspicious isolates are now routinely identified to the species level. In this study, we performed a retrospective data review (2012 to 2015) and utilized site-specific laboratory criteria and chart reviews to identify species within the diphtheroid classification representative of true infection versus contamination. Our data set included 762 isolates from 13 genera constituting 41 bacterial species. Only 18% represented true infection, and 82% were deemed contaminants. Clinically significant isolates were identified in anaerobic wounds (18%), aerobic wounds (30%), blood (5.5%), urine (22%), cerebrospinal fluid (24%), ophthalmologic cultures (8%), and sterile sites (20%). Organisms deemed clinically significant included multiple Actinomyces species in wounds, Propionibacterium species in joints and cerebrospinal fluid associated with central nervous system hardware, Corynebacterium kroppenstedtii (100%) in breast, and Corynebacterium striatum in multiple sites. Novel findings include clinically significant urinary tract infections by Actinomyces neuii (21%) and Corynebacterium aurimucosum (21%). Taken together, these findings indicate that species-level identification of diphtheroids isolated with a priori suspicion of infection is essential to accurately determine whether an isolate belongs to a species associated with specific types of infection.
Collapse
|
19
|
Actinotignum (formerly Actinobaculum) schaalii: a review of MALDI-TOF for identification of clinical isolates, and a proposed method for presumptive phenotypic identification. Pathology 2016; 48:367-71. [PMID: 27131934 DOI: 10.1016/j.pathol.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 03/12/2016] [Accepted: 03/21/2016] [Indexed: 12/21/2022]
Abstract
Actinotignum schaalii is a recognised cause of urinary tract infection. Following a case of urosepsis, 20 isolates of A. schaalii were collected over an initial 18 month period from urine and blood culture. An additional 25 isolates were collected over the following 13 months. Actinotignum schaalii had likely been overlooked or dismissed as a contaminant in our laboratory prior to this study period. It grows slowly on blood agar with supplemental CO2 or anaerobically. It may not grow on MacConkey agar or chromogenic agars used for routine urine culture. Repeated attempts at identification by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) may be required as the optimal age of cultures for testing is unclear. Utilising its characteristic antibiogram may assist phenotypic identification of this organism which is otherwise difficult to distinguish from other actinomycetes.
Collapse
|
20
|
Groah SL, Pérez-Losada M, Caldovic L, Ljungberg IH, Sprague BM, Castro-Nallar E, Chandel NJ, Hsieh MH, Pohl HG. Redefining Healthy Urine: A Cross-Sectional Exploratory Metagenomic Study of People With and Without Bladder Dysfunction. J Urol 2016; 196:579-87. [PMID: 26807926 DOI: 10.1016/j.juro.2016.01.088] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE We used the PathoScope platform to perform species level analyses of publicly available, 16S rRNA pyrosequenced, asymptomatic urine data to determine relationships between microbiomes, and clinical and functional phenotypes. MATERIALS AND METHODS We reanalyzed previously reported, cross-sectionally acquired urine samples from 47 asymptomatic subjects, including 23 controls and 24 subjects with neuropathic bladder. Urine was originally collected by the usual method of bladder drainage and analyzed by urinalysis, culture and pyrosequencing. Urinalysis and culture values were stratified as leukocyte esterase (0, or 1 or greater), nitrite (positive or negative), pyuria (fewer than 5, or 5 or greater white blood cells per high power field), cloudy urine (positive or negative) and urine culture bacterial growth (less than 50,000, or 50,000 or greater cfu/ml). PathoScope was used for next generation sequencing alignment, bacterial classification and microbial diversity characterization. RESULTS Subjects with neuropathic bladder were significantly more likely to have positive leukocyte esterase and pyuria, cloudy urine and bacterial growth. Of 47 samples 23 showed bacterial growth on culture and in all samples bacteria were identified by pyrosequencing. Nonneuropathic bladder urine microbiomes included greater proportions of Lactobacillus crispatus in females and Staphylococcus haemolyticus in males. The Lactobacillus community differed significantly among females depending on bladder function. Irrespective of gender the subjects with neuropathic bladder had greater proportions of Enterococcus faecalis, Proteus mirabilis and Klebsiella pneumonia. In 4 subjects with neuropathic bladder Actinobaculum sp. was detected by sequencing and by PathoScope but not by cultivation and in all cases it was associated with pyuria. CONCLUSIONS Using PathoScope plus 16S pyrosequencing we were able to identify unique, phenotype dependent, species level microbes. Novel findings included absent L. crispatus in the urine of females with neuropathic bladder and the presence of Actinobaculum only in subjects with neuropathic bladder.
Collapse
Affiliation(s)
- Suzanne L Groah
- MedStar National Rehabilitation Hospital, Washington, D.C.; Department of Rehabilitation Medicine, Georgetown University Hospital, Washington, D.C..
| | - Marcos Pérez-Losada
- Department of Integrative Systems Biology, Children's National Health System, Washington, D.C.; Computational Biology Institute, George Washington University, Ashburn, Virginia; CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, Portugal
| | - Ljubica Caldovic
- Department of Integrative Systems Biology, Children's National Health System, Washington, D.C
| | | | - Bruce M Sprague
- Division of Urology, Children's National Health System, Washington, D.C
| | - Eduardo Castro-Nallar
- Computational Biology Institute, George Washington University, Ashburn, Virginia; Center for Bioinformatics and Integrative Biology, Facultad de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
| | - Neel J Chandel
- MedStar National Rehabilitation Hospital, Washington, D.C
| | - Michael H Hsieh
- Division of Urology, Children's National Health System, Washington, D.C
| | - Hans G Pohl
- Division of Urology, Children's National Health System, Washington, D.C
| |
Collapse
|
21
|
Jacquier H, Benmansour H, Zadegan F, Hannouche D, Micaelo M, Mongiat-Artus P, Salomon E, Cambau E, Berçot B. Actinobaculum schaalii, a new cause of knee prosthetic joint infection in elderly. Infection 2015; 44:547-9. [PMID: 26680782 DOI: 10.1007/s15010-015-0864-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- H Jacquier
- Service de Bactériologie-Virologie, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France.
- INSERM, IAME, UMR 1137, 75018, Paris, France.
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, 75018, Paris, France.
| | - H Benmansour
- Service de Bactériologie-Virologie, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France
| | - F Zadegan
- Service de Chirurgie Orthopédique et Traumatologique, Centre de Reference Associé des Infections Osteo-Articulaires d'Ile de France (CRIOA), APHP, Hôpital Lariboisière, 75010, Paris, France
- CNRS, B2OA, UMR 7052, Univ Paris-Diderot, Paris, France
| | - D Hannouche
- Service de Chirurgie Orthopédique et Traumatologique, Centre de Reference Associé des Infections Osteo-Articulaires d'Ile de France (CRIOA), APHP, Hôpital Lariboisière, 75010, Paris, France
- CNRS, B2OA, UMR 7052, Univ Paris-Diderot, Paris, France
| | - M Micaelo
- Service de Bactériologie-Virologie, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France
- INSERM, IAME, UMR 1137, 75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, 75018, Paris, France
| | - P Mongiat-Artus
- Département d'Urologie, Univ Paris-Diderot, APHP, Hôpital Universitaire Saint-Louis, Paris, France
| | - E Salomon
- Service de Bactériologie-Virologie, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France
| | - E Cambau
- Service de Bactériologie-Virologie, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France
- INSERM, IAME, UMR 1137, 75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, 75018, Paris, France
| | - B Berçot
- Service de Bactériologie-Virologie, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010, Paris, France
- INSERM, IAME, UMR 1137, 75018, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, 75018, Paris, France
| |
Collapse
|
22
|
Lotte R, Lotte L, Ruimy R. Actinotignum schaalii (formerly Actinobaculum schaalii): a newly recognized pathogen-review of the literature. Clin Microbiol Infect 2015; 22:28-36. [PMID: 26577137 DOI: 10.1016/j.cmi.2015.10.038] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022]
Abstract
The genus Actinotignum contains three species, Actinotignum schaalii (formerly Actinobaculum schaalii), Actinotignum urinale and Actinotignum sanguinis. A. schaalii is the species most frequently involved in human infections, with 172 cases, mostly urinary tract infections (UTIs), reported so far. Invasive infections have also been described. This facultative anaerobic Gram-positive rod is part of the urinary microbiota of healthy patients. It is responsible for UTIs, particularly in elderly men and young children. A. schaalii is an underestimated cause of UTIs because of its fastidious growth on usual media and difficulties associated with its identification using phenotypic methods. Indeed, this slow-growth bacterium requires blood-enriched media and an incubation time of 48 hours under anaerobic or 5% CO2 atmosphere. Furthermore, only matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) or molecular-based methods allow the accurate identification of this bacteria. MALDI-TOF using Microflex LT with the Biotyper database (Bruker Daltonics, Bremen, Germany) is the most reliable technology for the routine identification of A. schaalii. The identification of this uropathogen is all the more important because it is resistant to trimethoprim/sulfamethoxazole and second-generation quinolones that are widely used in the treatment of UTIs. Antimicrobial therapy using β-lactams prolonged for up to 2 weeks is the most efficient treatment and should be recommended. Microbiologists should assess the presence of A. schaalii in urine using appropriate culture and identification methods in the case of a direct examination that is positive for small coccoid rods, a negative nitrite urinary stick associated with leukocyturia, treatment failure with trimethoprim/sulfamethoxazole or fluoroquinolones, or undocumented, repeated UTIs.
Collapse
Affiliation(s)
- R Lotte
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France; INSERM U1065 (C3M), Bacterial Toxins in Host Pathogen Interactions, C3M, Bâtiment Universitaire Archimed, Nice, France.
| | - L Lotte
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France
| | - R Ruimy
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France; INSERM U1065 (C3M), Bacterial Toxins in Host Pathogen Interactions, C3M, Bâtiment Universitaire Archimed, Nice, France
| |
Collapse
|
23
|
Answer to November 2015 Photo Quiz. J Clin Microbiol 2015. [DOI: 10.1128/jcm.02429-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
24
|
A validation of the Danish microbiology database (MiBa) and incidence rate of Actinotignum schaalii (Actinobaculum schaalii) bacteraemia in Denmark. Clin Microbiol Infect 2015; 21:1097.e1-4. [PMID: 26319901 DOI: 10.1016/j.cmi.2015.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/05/2015] [Accepted: 08/17/2015] [Indexed: 11/22/2022]
Abstract
Actinotignum schaalii (former named Actinobaculum schaalii) can cause urinary tract infections (UTIs) and bacteraemia, mainly in the elderly. A. schaalii is difficult to identify with conventional biochemical tests, and it is often overlooked if the urine is only cultured in ambient air. The aim of this study was to validate data from the nationwide Danish microbiology database (MiBa) with data from the laboratory information system (LIS) at the local department of microbiology in Viborg-Herning, and to evaluate the incidence rate of bacteraemia caused by A. schaalii in Denmark by using data from the MiBa. All departments of microbiology in Denmark report data to the MiBa. All microbiological samples with A. schaalii in Denmark were extracted for a period of 5 years from the MiBa and from the local LISs. All data obtained from our local LIS were also found in the MiBa, except for data on real-time PCR, which were not registered, owing to missing ID codes in the MiBa. From 2010 to 2014, there was a significant increase in the incidence rate of blood cultures with A. schaalii, from 1.8 to 6.8 cases per million, which was probably due to coincident implementation of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) in routine diagnostics. We found that A. schaalii caused bacteraemia and UTIs mainly in the elderly. In conclusion, the MiBa can be a useful source of nationwide microbiological data in Denmark. Our results suggest that the incidence rate of A. schaalii as a cause of bacteraemia has been underestimated, and that culture of urine in CO2 can improve the detection of A. schaalii.
Collapse
|
25
|
Performance of a New Rapid Immunoassay Test Kit for Point-of-Care Diagnosis of Significant Bacteriuria. J Clin Microbiol 2015; 53:2805-9. [PMID: 26063858 DOI: 10.1128/jcm.00353-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/25/2015] [Indexed: 12/16/2022] Open
Abstract
Urinary tract infections (UTIs) are frequently encountered in clinical practice and most commonly caused by Escherichia coli and other Gram-negative uropathogens. We tested RapidBac, a rapid immunoassay for bacteriuria developed by Silver Lake Research Corporation (SLRC), compared with standard bacterial culture using 966 clean-catch urine specimens submitted to a clinical microbiology laboratory in an urban academic medical center. RapidBac was performed in accordance with instructions, providing a positive or negative result in 20 min. RapidBac identified as positive 245/285 (sensitivity 86%) samples with significant bacteriuria, defined as the presence of a Gram-negative uropathogen or Staphylococcus saprophyticus at ≥10(3) CFU/ml. The sensitivities for Gram-negative bacteriuria at ≥10(4) CFU/ml and ≥10(5) CFU/ml were 96% and 99%, respectively. The specificity of the test, detecting the absence of significant bacteriuria, was 94%. The sensitivity and specificity of RapidBac were similar on samples from inpatient and outpatient settings, from male and female patients, and across age groups from 18 to 89 years old, although specificity was higher in men (100%) compared with that in women (92%). The RapidBac test for bacteriuria may be effective as an aid in the point-of-care diagnosis of UTIs especially in emergency and primary care settings.
Collapse
|
26
|
Abstract
Actinomyces israelii has long been recognized as a causative agent of actinomycosis. During the past 3 decades, a large number of novel Actinomyces species have been described. Their detection and identification in clinical microbiology laboratories and recognition as pathogens in clinical settings can be challenging. With the introduction of advanced molecular methods, knowledge about their clinical relevance is gradually increasing, and the spectrum of diseases associated with Actinomyces and Actinomyces-like organisms is widening accordingly; for example, Actinomyces meyeri, Actinomyces neuii, and Actinomyces turicensis as well as Actinotignum (formerly Actinobaculum) schaalii are emerging as important causes of specific infections at various body sites. In the present review, we have gathered this information to provide a comprehensive and microbiologically consistent overview of the significance of Actinomyces and some closely related taxa in human infections.
Collapse
|
27
|
Non LR, Nazinitsky A, Gonzalez MD, Burnham CAD, Patel R. Actinobaculum schaalii bacteremia: A report of two cases. Anaerobe 2015; 34:84-5. [PMID: 25881498 DOI: 10.1016/j.anaerobe.2015.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/27/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
We report two cases of bacteremia with Actinobaculum schaalii, a rarely reported, anaerobic, Gram-positive bacterium. The first case was a patient with renal cancer who developed pyelonephritis after cryoablation, and the second was a patient who developed sepsis after a urogenital procedure. Bacteremia resolved after administration of empiric antibiotic therapy.
Collapse
Affiliation(s)
- Lemuel R Non
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, USA.
| | - Allison Nazinitsky
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, USA
| | - Mark D Gonzalez
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, USA
| | - Carey-Ann D Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, USA
| | - Rupa Patel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, USA
| |
Collapse
|
28
|
Le Brun C, Robert S, Tanchoux C, Bruyere F, Lanotte P. Urinary tract infection caused by Actinobaculum schaalii: a urosepsis pathogen that should not be underestimated. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cécile Le Brun
- Laboratoire de Bactériologie–Virologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| | - Sylvie Robert
- Laboratoire de Bactériologie–Virologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| | - Colas Tanchoux
- Service d'Urologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| | - Franck Bruyere
- Service d'Urologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| | - Philippe Lanotte
- Laboratoire de Bactériologie–Virologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| |
Collapse
|
29
|
Le Brun C, Robert S, Bruyere F, Lanotte P. [Emerging uropathogens: Point for urologists and biologists]. Prog Urol 2015; 25:363-9. [PMID: 25726694 DOI: 10.1016/j.purol.2015.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/24/2015] [Accepted: 01/30/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Technological advances during the last years in bacterial identification by molecular biology and mass spectrometry, or Matrix Assisted Laser Desorption Ionisation-Time of Flight (MALDI-TOF) have allowed identifying new bacteria involved in urinary tract infections. The purpose of this review is to familiarize clinicians with these bacteria so that they can look at a particular target population and help biologists to suspect and identify them. METHOD A bibliographic research was performed using the Medline database concerning the keywords Aerococcus, Actinobaculum, Alloscardovia, Trueperella. RESULTS If Aerococcus sp. is now well known, Actinobaculum sp., Alloscardovia sp. and Trueperella sp. remain rarely isolated and unknown from clinicians. Importance of these germs could be underestimated because of the identifying and isolation difficulties which existed beforehand. They are particularly found in a population of elderly people with underlying conditions or urological risk factors of urinary tract infection. Actinobaculum schaalii is also found more frequently in young children. CONCLUSION Aerococcus sp. et A. schaalii are true uropathogens not to be underestimated. Further studies are still needed to confirm the specific involvement of Trueperella and Alloscardovia in urinary diseases.
Collapse
Affiliation(s)
- C Le Brun
- Laboratoire de bactériologie-virologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnelé, 37044 Tours cedex, France.
| | - S Robert
- Laboratoire de bactériologie-virologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnelé, 37044 Tours cedex, France
| | - F Bruyere
- Service d'urologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnelé, 37044 Tours cedex, France
| | - P Lanotte
- Laboratoire de bactériologie-virologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnelé, 37044 Tours cedex, France
| |
Collapse
|
30
|
Yassin AF, Spröer C, Pukall R, Sylvester M, Siering C, Schumann P. Dissection of the genus Actinobaculum: Reclassification of Actinobaculum schaalii Lawson et al. 1997 and Actinobaculum urinale Hall et al. 2003 as Actinotignum schaalii gen. nov., comb. nov. and Actinotignum urinale comb. nov., description of Actinotignum sanguinis sp. nov. and emended descriptions of the genus Actinobaculum and Actinobaculum suis; and re-examination of the culture deposited as Actinobaculum massiliense CCUG 47753T ( = DSM 19118T), revealing that it does not represent a strain of this species. Int J Syst Evol Microbiol 2014; 65:615-624. [PMID: 25406238 DOI: 10.1099/ijs.0.069294-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The remarkable host specificity of the species of the genus Actinobaculum led us to recharacterize these species by a polyphasic approach. A comparative chemotaxonomic study including analysis of whole-cell sugars, amino acid composition of the peptidoglycan, fatty acid methyl esters, respiratory quinones and polar lipids revealed significant differences that, in combination with molecular data, support a dissection of the genus Actinobaculum. The proposals of this study include the reclassification of Actinobaculum schaalii and Actinobaculum urinale as Actinotignum schaalii gen. nov., comb. nov. (type strain DSM 15541(T) = CCUG 27420(T)) and Actinotignum urinale comb. nov. (type strain DSM 15805(T) = CCUG 46093(T)), respectively. Emended descriptions of the genus Actinobaculum and Actinomyces suis are also provided. The results of 16S rRNA gene sequence analysis and DNA-DNA hybridization also indicated that the type strain of Actinobaculum massiliense deposited as CCUG 47753(T) ( = DSM 19118(T)) should in fact be considered a member of the species Actinobaculum schaalii. In addition, comparative 16S rRNA gene sequencing and DNA-DNA relatedness studies of four strains recovered from clinical materials demonstrated that three of the isolates belonged to Actinotignum schaalii; the remaining strain represents a novel species, for which the name Actinotignum sanguinis sp. nov. is proposed. The type strain is IMMIB L-2199(T) ( = DSM 26039(T) = CCUG 64068(T)).
Collapse
Affiliation(s)
- A F Yassin
- Institut für Medizinische Mikrobiologie und Immunologie der Universität Bonn, Sigmund-Freud-Straße 25, D-53127 Bonn, Germany
| | - C Spröer
- Leibniz Institut DSMZ - Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH, Inhoffenstrasse 7b, D-38124 Braunschweig, Germany
| | - R Pukall
- Leibniz Institut DSMZ - Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH, Inhoffenstrasse 7b, D-38124 Braunschweig, Germany
| | - M Sylvester
- Institut für Biochemie und Molekularbiologie Universitätsklinikum Bonn, Nussallee 11, D-53115 Bonn, Germany
| | - C Siering
- Institut für Organische Chemie, Johannes Gutenberg-Universität Mainz, Duesbergweg 10-14, D-55128 Mainz, Germany
| | - P Schumann
- Leibniz Institut DSMZ - Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH, Inhoffenstrasse 7b, D-38124 Braunschweig, Germany
| |
Collapse
|
31
|
Complete Genome Sequence of Actinobaculum schaalii Strain CCUG 27420. GENOME ANNOUNCEMENTS 2014; 2:2/5/e00880-14. [PMID: 25189588 PMCID: PMC4155593 DOI: 10.1128/genomea.00880-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Complete genome sequencing of the emerging uropathogen Actinobaculum schaalii indicates that an important mechanism of its virulence is attachment pili, which allow the organism to adhere to the surface of animal cells, greatly enhancing the ability of this organism to colonize the urinary tract.
Collapse
|
32
|
Skin and soft-tissue infections caused by Actinobaculum schaalii: report of two cases and literature review. Anaerobe 2014; 28:95-7. [PMID: 24923266 DOI: 10.1016/j.anaerobe.2014.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 11/24/2022]
Abstract
Skin and soft-tissue infections (SSTIs) caused by Actinobaculum spp. are very rare. In the present study, we report two cases and review the literature. The first case was an immunocompromised patient with an extensive cellulitis secondary to an inguinal abscess, and the second case was a patient with a pilonidal abscess. Clinical outcomes of both patients were good after surgical drainage and treatment with cloxacillin. The review of the literature showed that SSTIs caused by Actinobaculum spp. are usually located on the perineal and inguinal regions and can be severe, particularly in immunocompromised patients. SSTIs caused by Actinobaculum spp. can be overlooked because identification is often difficult and they can be considered as contaminants.
Collapse
|
33
|
Sandlund J, Glimåker M, Svahn A, Brauner A. Bacteraemia caused by Actinobaculum schaalii: An overlooked pathogen? ACTA ACUST UNITED AC 2014; 46:605-8. [PMID: 24840345 DOI: 10.3109/00365548.2014.913306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Actinobaculum schaalii is a uropathogen resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. It requires a long culture time and specific conditions, and is therefore easily overgrown by other bacteria and regarded as part of the normal bacterial flora. We review 17 cases of A. schaalii bacteraemia, demonstrating its invasive potential. A. schaalii should always be ruled out as causative agent in patients with urinary tract infection or urosepticaemia with treatment failure.
Collapse
Affiliation(s)
- Johanna Sandlund
- From the 1 Infectious Diseases Unit, Department of Medicine Solna, Karolinska Institute
| | | | | | | |
Collapse
|
34
|
Bank S, Cattoir V, Lienhard R, Grisold AJ, Thomsen TR, Reinhard M, Olsen AB, Christensen JJ, Søby KM, Prag J. Recommendations for optimal detection and identification ofActinobaculum schaaliiin urine. APMIS 2014; 122:1043-4. [DOI: 10.1111/apm.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Steffen Bank
- Department of Clinical Microbiology; Viborg Regional Hospital; Viborg Denmark
| | | | | | - Andrea J. Grisold
- Institute of Hygiene, Microbiology and Environmental Medicine; Medical University of Graz; Graz Austria
| | - Trine R. Thomsen
- Department of Biotechnology; Aalborg University and Section for Medical Biotechnology; The Danish Technological Institute; Taastrup Denmark
| | - Mark Reinhard
- Department of Internal Medicine; Viborg Regional Hospital; Viborg Denmark
| | | | | | - Karen Marie Søby
- Department of Clinical Microbiology; Viborg Regional Hospital; Viborg Denmark
| | - Jørgen Prag
- Department of Clinical Microbiology; Viborg Regional Hospital; Viborg Denmark
| |
Collapse
|
35
|
Tuuminen T, Suomala P, Harju I. Actinobaculum schaalii: identification with MALDI-TOF. New Microbes New Infect 2014; 2:38-41. [PMID: 25356339 PMCID: PMC4184588 DOI: 10.1002/2052-2975.32] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
Actinobaculum schaalii is an emerging uropathogen. So far, its identification has been performed with 16S rRNA gene sequencing or PCR. The diagnosis has often been delayed due to fastidious growth and identification problems. Eleven clinical isolates of A. schaalii from bloodstream infections that were initially identified with 16S rRNA sequencing analysis were recovered and later identified with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF). We present a review of bacteriological data of these patients, an algorithm for fast laboratory work-up and advocate the use of sensitized culture of urine to allow better recovery of A. schaalii in susceptible patients.
Collapse
Affiliation(s)
- T Tuuminen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki Helsinki, Finland ; Eastern Finland Laboratory Centre Joint Authority Enterprise, Mikkeli District Laboratory Finland
| | - P Suomala
- Eastern Finland Laboratory Centre Joint Authority Enterprise, Mikkeli District Laboratory Finland
| | - I Harju
- Clinical Microbiology Laboratory, Turku University Hospital Turku, Finland
| |
Collapse
|
36
|
Jensen KH, Dargis R, Christensen JJ, Kemp M. Ribosomal PCR and DNA sequencing for detection and identification of bacteria: experience from 6 years of routine analyses of patient samples. APMIS 2013; 122:248-55. [PMID: 23879657 DOI: 10.1111/apm.12139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 05/22/2013] [Indexed: 11/29/2022]
Abstract
The use of broad range PCR and DNA sequencing of bacterial 16S ribosomal RNA genes for routine diagnostics of bacterial infections was evaluated. Here, the results from more than 2600 analyses during a 6-year period (2003-2009) are presented. Almost half of the samples were from joints and bones, and the second most frequent origin of samples was from the central nervous system. Overall, 26% of all samples were positive for bacterial DNA and bacterial identification was obtained in 80% of the PCR-positive samples by subsequent DNA sequencing. Ambiguous species identification was noticed among non-haemolytic streptococci, especially within the mitis group. The data show that ribosomal PCR with subsequent DNA sequencing of the PCR product is a most valuable supplement to culture for identifying bacterial agents of both acute and prolonged infections. However, some bacteria, including non-haemolytic streptococci, may not be precisely identified.
Collapse
Affiliation(s)
- Kristine Helander Jensen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark; Department of Science, Systems and Model, Roskilde University, Roskilde, Denmark; Department of Clinical Microbiology, Odense university Hospital, Odense, Denmark
| | | | | | | |
Collapse
|
37
|
van Aarle S, Arents NLA, de Laet K. Actinobaculum schaalii causing epididymitis in an elderly patient. J Med Microbiol 2013; 62:1092-1093. [PMID: 23682167 DOI: 10.1099/jmm.0.048611-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Actinobaculum schaalii is a Gram-positive coccoid rod that causes various infections in humans and is easily overlooked in cultures. A. schaalii has long been thought to be of low prevalence and limited invasive potential, causing benign cystitis in elderly patients with underlying urological conditions. Here, we report the first case of epididymitis caused by this bacterium.
Collapse
Affiliation(s)
- S van Aarle
- Department of Urology, Maxima Medical Center, Veldhoven, The Netherlands
| | - N L A Arents
- Department of Microbiology, PAMM Foundation, Veldhoven, The Netherlands
| | - K de Laet
- Department of Urology, Maxima Medical Center, Veldhoven, The Netherlands
| |
Collapse
|
38
|
Torres-Sangiao E, Lissarrague-Sanz A, Cañizares-Castellanos A, Bou G. Prostatitis bacteriana. Enferm Infecc Microbiol Clin 2013; 31:344-6. [DOI: 10.1016/j.eimc.2012.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 11/26/2022]
|
39
|
Olsen AB, Andersen PK, Bank S, Søby KM, Lund L, Prag J. Actinobaculum schaalii, a commensal of the urogenital area. BJU Int 2013; 112:394-7. [PMID: 23350855 DOI: 10.1111/j.1464-410x.2012.11739.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Actinobaculum schaalii is considered to be a part of the normai flora in the genital and urinary tract area. It has been associated to urinary tract infection (UTI), sepsis, osteomyelitis, endocarditis and Foumier's gangrene. So far it has mainly been isolated from urine, blood and pus, and predominantly in elderly patients. This study examined the habitat of A. schaalii by collecting samples from skin and urine in patients with kidney or ureter stones before and after treatment with Extracorporeal Shock Wave Lithotripsy (ESWL). Additionally faeces and vaginal swabs from routine specimen in patients not undergoing ESWL and without known urinary calculi were also analysed. The study does not find A. schaalii in faeces but shows it to be presents on skin and mucosa in the genital area. A. schaalii is also shown a possible pathogen in the stone-patient group undergoing ESWL. OBJECTIVE To study the habitat of Actinobaculum schaalii by examing groin swabs, faeces samples and vaginal swabs, and to determine whether it is a common uropathogen in patients with kidney or ureter stones. PATIENTS AND METHODS A quantitative real-time PCR assay was used to analyse all samples, which were collected between 2010 and 2011. A total of 38 patients (24 men and 14 women), with kidney or ureter stones and undergoing extracorporeal shock wave lithotripsy (ESWL), provided urine samples and had groin swabs taken. In addition, 30 faecal samples and 19 vaginal swabs that had been sent for routine microbiological examinations from patients outside the ESWL group were analysed. A chi-squared test was used to analyse the differences between patient groups, studying samples from urine, faeces samples, groin swabs and vaginal swabs. RESULTS Actinobaculum schaalii was found in the urine samples from 14 (37%) patients undergoing ESWL, and in both urine and groin swabs from seven (18%) patients. Actinobaculum schaalii was not found in faeces samples but it was found in six (32%) of the vaginal swabs, predominantly in patients >50 years (P = 0.06). CONCLUSION The study indicates that A. schaalii is a commensal found on skin, urine and vaginal mucosa in the human urogenital area and supports other investigations in its finding that the elderly are at greatest risk of being colonized with A. schaalii.
Collapse
Affiliation(s)
- Anne B Olsen
- Department of Urology, Viborg Hospital, Viborg, Denmark.
| | | | | | | | | | | |
Collapse
|
40
|
Zimmermann P, Berlinger L, Liniger B, Grunt S, Agyeman P, Ritz N. Actinobaculum schaalii an emerging pediatric pathogen? BMC Infect Dis 2012; 12:201. [PMID: 22928807 PMCID: PMC3457841 DOI: 10.1186/1471-2334-12-201] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 08/15/2012] [Indexed: 11/24/2022] Open
Abstract
Background Actinobaculum schaalii was first described as a causative agent for human infection in 1997. Since then it has mainly been reported causing urinary tract infections (UTI) in elderly individuals with underlying urological diseases. Isolation and identification is challenging and often needs molecular techniques. A. schaalii is increasingly reported as a cause of infection in humans, however data in children is very limited. Case presentation We present the case of an 8-month-old Caucasian boy suffering from myelomeningocele and neurogenic bladder who presented with a UTI. An ultrasound of the urinary tract was unremarkable. Urinalysis and microscopy showed an elevated leukocyte esterase test, pyuria and a high number of bacteria. Empiric treatment with oral co-trimoxazole was started. Growth of small colonies of Gram-positive rods was observed after 48 h. Sequencing of the 16S rRNA gene confirmed an A. schaalii infection 9 days later. Treatment was changed to oral amoxicillin for 14 days. On follow-up urinalysis was normal and urine cultures were negative. Conclusions A.schaalii is an emerging pathogen in adults and children. Colonization and subsequent infection seem to be influenced by the age of the patient. In young children with high suspicion of UTI who use diapers or in children who have known abnormalities of their urogenital tract, infection with A. schaalii should be considered and empiric antimicrobial therapy chosen accordingly.
Collapse
Affiliation(s)
- Petra Zimmermann
- Department of Paediatrics, University Children's Hospital, Berne, Switzerland
| | | | | | | | | | | |
Collapse
|
41
|
Alvarez-Paredes L, López-García P, Ruiz-García M, Royo-García G. [Actinobaculum schaalii infection]. Enferm Infecc Microbiol Clin 2012; 30:505-6. [PMID: 22749060 DOI: 10.1016/j.eimc.2012.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 03/07/2012] [Accepted: 04/10/2012] [Indexed: 11/27/2022]
|
42
|
Salvadó M, Plasencia V, Segura C, Gómez J, Medina MJ, Sáez-Nieto JA, Castellanos S, Horcajada JP. Infection due to Actinobaculum spp: report of 12 patients in Spain. J Infect 2012; 66:107-9. [PMID: 22750149 DOI: 10.1016/j.jinf.2012.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/22/2012] [Accepted: 06/23/2012] [Indexed: 11/27/2022]
|
43
|
Evaluation of the Andromas matrix-assisted laser desorption ionization-time of flight mass spectrometry system for identification of aerobically growing Gram-positive bacilli. J Clin Microbiol 2012; 50:2702-7. [PMID: 22692743 DOI: 10.1128/jcm.00368-12] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Matrix-associated laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is a rapid and simple microbial identification method. Previous reports using the Biotyper system suggested that this technique requires a preliminary extraction step to identify Gram-positive rods (GPRs), a technical issue that may limit the routine use of this technique to identify pathogenic GPRs in the clinical setting. We tested the accuracy of the MALDI-TOF MS Andromas strategy to identify a set of 659 GPR isolates representing 16 bacterial genera and 72 species by the direct colony method. This bacterial collection included 40 C. diphtheriae, 13 C. pseudotuberculosis, 19 C. ulcerans, and 270 other Corynebacterium isolates, 32 L. monocytogenes and 24 other Listeria isolates, 46 Nocardia, 75 Actinomyces, 18 Actinobaculum, 11 Propionibacterium acnes, 18 Propionibacterium avidum, 30 Lactobacillus, 21 Bacillus, 2 Rhodococcus equi, 2 Erysipelothrix rhusiopathiae, and 38 other GPR isolates, all identified by reference techniques. Totals of 98.5% and 1.2% of non-Listeria GPR isolates were identified to the species or genus level, respectively. Except for L. grayi isolates that were identified to the species level, all other Listeria isolates were identified to the genus level because of highly similar spectra. These data demonstrate that rapid identification of pathogenic GPRs can be obtained without an extraction step by MALDI-TOF mass spectrometry.
Collapse
|
44
|
Kemp M, Dargis R, Andresen K, Christensen JJE. A program against bacterial bioterrorism: improved patient management and acquisition of new knowledge on infectious diseases. Biosecur Bioterror 2012; 10:203-7. [PMID: 22571372 DOI: 10.1089/bsp.2011.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2002 it was decided to establish laboratory facilities in Denmark for diagnosing agents associated with bioterrorism in order to make an immediate appropriate response to the release of such agents possible. Molecular assays for detection of specific agents and molecular and proteomic techniques for identification of bacteria were introduced as part of the program. All assays and techniques were made accessible for use in diagnosing patients, even when an intentional release was not suspected. Medical expertise on different diseases was established at the department as an integrated part of the program. The analyses included PCR assays for specific bacteria, identification of isolated bacteria by DNA sequencing, detection and identification of bacteria in clinical sample material by universal bacterial PCR and DNA sequencing, and identification of bacteria by mass spectrometry. The established analyses formed a basis on which a series of further developments was built. In addition to reducing the time for obtaining diagnoses and improving the accuracy of diagnosis of individual infected patients, the analyses provided new knowledge on the frequency and distribution of some bacterial infections, including Q fever, tularemia, trench fever, brucellosis, and melioidosis. The implementation of an antibioterrorism program in a clinical diagnostic setting improved the diagnostic possibilities for patients in Denmark and provided new epidemiologic information. It also introduced a number of diagnostic assays for bacterial infections not associated with bioterrorism that are difficult to culture or identify.
Collapse
Affiliation(s)
- Michael Kemp
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark.
| | | | | | | |
Collapse
|
45
|
Andersen LB, Bank S, Hertz B, Søby KM, Prag J. Actinobaculum schaalii, a cause of urinary tract infections in children? Acta Paediatr 2012; 101:e232-4. [PMID: 22211919 DOI: 10.1111/j.1651-2227.2011.02586.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To inform that Actinobaculum schaalii can colonize the urine and cause urinary tract infection in children. METHODS Urine samples were examined by wet smear microscopy, incubated in 5% CO(2) for 1-2 days, and species-specific real-time polymerase chain reaction (PCR) for A. schaalii was performed. RESULTS In 5 of the 29 screened urines, A. schaalii was found only by real-time PCR in quantities equivalent to ≥ 10(4) -10(5) CFU/mL. In addition, A. schaalii was found in quantities equivalent to ≥ 10(6) CFU/mL by both culture and PCR in two children with a urinary tract infection and large numbers of leucocytes in the urine. CONCLUSION Actinobaculum schaalii is CO(2)-dependent. Therefore, if there are clinical symptoms and/or a negative culture despite the presence of leucocytes in the urine, Gram staining and incubation in 5% CO(2) or species-specific real-time PCR should be performed to identify A. schaalii.
Collapse
|
46
|
Actinobaculum schaalii: An Emerging Uropathogen? Case Rep Urol 2012; 2012:468516. [PMID: 22606634 PMCID: PMC3350018 DOI: 10.1155/2012/468516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/26/2012] [Indexed: 11/17/2022] Open
Abstract
A. schaalii is a rare uropathogen. We report urosepsis with Actinobaculum schaalii detected serendipitously in blood and urine culture in a 79-year-old with urinary tract obstruction. This paper illuminates the flaws in our current system in detecting A. schaalii and raises awareness among clinicians and laboratory teams.
Collapse
|
47
|
Abstract
Clinical urine specimens are usually considered to be sterile when they do not yield uropathogens using standard clinical cultivation procedures. Our aim was to test if the adult female bladder might contain bacteria that are not identified by these routine procedures. An additional aim was to identify and recommend the appropriate urine collection method for the study of bacterial communities in the female bladder. Consenting participants who were free of known urinary tract infection provided urine samples by voided, transurethral, and/or suprapubic collection methods. The presence of bacteria in these samples was assessed by bacterial culture, light microscopy, and 16S rRNA gene sequencing. Bacteria that are not or cannot be routinely cultivated (hereinafter called uncultivated bacteria) were common in voided urine, urine collected by transurethral catheter (TUC), and urine collected by suprapubic aspirate (SPA), regardless of whether the subjects had urinary symptoms. Voided urine samples contained mixtures of urinary and genital tract bacteria. Communities identified in parallel urine samples collected by TUC and SPA were similar. Uncultivated bacteria are clearly present in the bladders of some women. It remains unclear if these bacteria are viable and/or if their presence is relevant to idiopathic urinary tract conditions.
Collapse
|
48
|
Cattoir V. Actinobaculum schaalii: review of an emerging uropathogen. J Infect 2011; 64:260-7. [PMID: 22209960 DOI: 10.1016/j.jinf.2011.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 12/05/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022]
Abstract
Actinobaculum schaalii is a facultative anaerobic, Gram-positive rod-shaped species phylogenetically related to Actinomyces that is likely part of the commensal flora of the human genitourinary tract. Because of its fastidious growth under aerobic conditions and its resemblance to bacteria of the resident flora, A. schaalii is frequently overlooked or considered as a contaminant. It is also difficult to identify phenotypically, still requiring molecular identification. Note that the recent technology of matrix-assisted laser desorption/ionisation time-of-flight-mass spectrometry could be a promising tool for its identification. Recent studies using sensitive PCR assays showed that its clinical significance was largely underestimated. Since its first description in 1997, A. schaalii has been responsible for numerous urinary tract infections (UTIs), mainly in elderly (usually >60 years) and patients with underlying urological conditions. Infected urines usually show many Gram-positive rods with significant leukocyturia and a negative test for nitrites. Numerous cases of severe infections have also been described, such as urosepsis, bacteremia, cellulitis, spondylodiscitis, and endocarditis. In vitro, A. schaalii is highly susceptible to β-lactams but it is resistant to ciprofloxacin and cotrimoxazole, first-choice antimicrobials for the oral treatment of UTIs. A penicillin (e.g. amoxicillin) or a cephalosporin (e.g. cefuroxime, ceftriaxone) should be the preferred treatment.
Collapse
Affiliation(s)
- Vincent Cattoir
- Centre National de Référence de la Résistance aux Antibiotiques, Laboratoire associé Entérocoques, Service de Microbiologie, CHU Côte de Nacre, Av. Côte de Nacre, 14033 Caen Cedex 9, France.
| |
Collapse
|
49
|
Tschudin-Sutter S, Frei R, Weisser M, Goldenberger D, Widmer AF. Actinobaculum schaalii - invasive pathogen or innocent bystander? A retrospective observational study. BMC Infect Dis 2011; 11:289. [PMID: 22029906 PMCID: PMC3252262 DOI: 10.1186/1471-2334-11-289] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 10/26/2011] [Indexed: 11/21/2022] Open
Abstract
Background Actinobaculum schaalii is a Gram-positive, facultative anaerobic coccoid rod, classified as a new genus in 1997. It grows slowly and therefore is easily overgrown by other pathogens, which are often found concomitantly. Since 1999, Actinobaculum schaalii is routinely investigated at our hospital, whenever its presence is suspected due to the detection of minute grey colonies on blood agar plates and negative reactions for catalase. The objective of this study was to determine the clinical significance of Actinobaculum schaalii, identified in our microbiology laboratory over the last 11 years. Methods All consecutive isolates with Actinobaculum schaalii were obtained from the computerized database of the clinical microbiology laboratory and patients whose cultures from any body site yielded this pathogen were analyzed. Observation of tiny colonies of Gram-positive, catalase-negative coccoid rods triggered molecular identification based on 16S rRNA gene sequencing. Results 40 isolates were obtained from 27 patients during the last 11 years. The patient's median age was 81 (19-101) years, 25 (92.6%) had underlying diseases and 12 (44.4%) had a genitourinary tract pathology. Actinobaculum schaalii was isolated in 12 urine cultures, 21 blood cultures, and 7 deep tissue biopsies. Twenty-five (62.5%) specimens were monobacterial, the remaining 15 (37.5%) were polybacterial 7/7 deep tissue samples (three bloodcultures and five urine cultures). Recovery from urine was interpreted as colonization in 5 (18.6%) cases (41.6% of all urine samples). Six (22.2%) suffered from urinary tract infections, six (22.2%) from abscesses (skin, intraabdominal, genitourinary tract, and surgical site infections) and 10 (37.0%) from bacteremia. Conclusions In this largest case series so far, detection of Actinobaculum schaalii was associated with an infection - primarily sepsis and abscesses - in 81.5% of our patients. Since this pathogen is frequently part of polymicrobial cultures (42.5%) it is often overlooked or considered a contaminant. Detection of Actinobaculum schaalii in clinical isolates mainly reflects infection indicating that this Gram-positive rod is not an innocent bystander.
Collapse
Affiliation(s)
- Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel, Switzerland
| | | | | | | | | |
Collapse
|
50
|
Abstract
Actinobaculum species are anaerobic Gram-positive rods that have previously been associated with urinary tract infection (UTI) in the elderly. We report 12 patients with Actinobaculum bacteremia. Only 40% of blood cultures were clinically considered significant by the treating physicians, but most patients were treated for UTI, suggesting a possible urinary source of bacteremia. Clinicians should be aware of the pathogenic potential of Actinobaculum spp.
Collapse
|