1
|
Langbour C, Mahmoud S, Coustillères F, Lartigue MF, René J. Aerococcus urinae infection of the pubic symphysis: A rare case report. IDCases 2023; 34:e01911. [PMID: 37928817 PMCID: PMC10622683 DOI: 10.1016/j.idcr.2023.e01911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Aerococcus urinae is a Gram-positive, catalase-negative coccus, rarely responsible for urinary tract infections and seldom described for musculoskeletal infections like spondylodiscitis. An 86-year-old man presented to our hospital for groin pain without fever. Pelvic CT-guided biopsy revealed an A. urinae pubic symphysis osteomyelitis. He received a treatment by amoxicillin per os for six weeks, and did not need any surgery. An eight -month- follow-up showed a favorable evolution. Pubic symphysis infection can be induced by a wide variety of pathogens, and may have very different clinical presentations. Some authors recommend systematic surgery, but in case of susceptible pathogen associated with a low level of joint destruction, medical treatment alone should be sufficient to cure and make surgery unnecessary.
Collapse
Affiliation(s)
- Camille Langbour
- CHU Tours, Service Rhumatologie, 37170 Chambray-les-Tours, France
| | - Sara Mahmoud
- CHU Tours, Service Rhumatologie, 37170 Chambray-les-Tours, France
| | | | - Marie-Frédérique Lartigue
- CHU Tours, Service de Bactériologie-Virologie-Hygiène, F-37044 Tours, France
- ISP, UMR1282, Université de Tours, INRAE, F-37032 Tours, France
| | - Jessica René
- CHU Tours, Service Rhumatologie, 37170 Chambray-les-Tours, France
- Université François Rabelais de Tours, 37000 Tours, France
| |
Collapse
|
2
|
Choi BI, Ene A, Du J, Johnson G, Putonti C, Schouw CH, Dargis R, Senneby E, Christensen JJ, Wolfe AJ. Taxonomic considerations on Aerococcus urinae with proposal of subdivision into Aerococcus urinae, Aerococcus tenax sp. nov., Aerococcus mictus sp. nov., and Aerococcus loyolae sp. nov. Int J Syst Evol Microbiol 2023; 73. [PMID: 37755156 DOI: 10.1099/ijsem.0.006066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Average nucleotide identity analysis, based on whole genome sequences of 115 strains previously identified as Aerococcus urinae, an emerging uropathogen, discriminates at least six unique genomic taxa. The whole genome analysis affords clearer species boundaries over 16S rRNA gene sequencing and traditional phenotypic approaches for the identification and phylogenetic organization of Aerococcus species. The newly described species can be differentiated by matrix-assisted laser desorption ionization time-of-flight analysis of protein signatures. We propose the emendation of the description of A. urinae (type strain ATCC 51268T = CCUG 34223T=NCFB 2893) and the names of Aerococcus tenax sp. nov. (ATCC TSD-302T = DSM 115700T = CCUG 76531T=NR-58630T), Aerococcus mictus sp. nov. (ATCC TSD-301T = DSM 115699T = CCUG 76532T=NR-58629T), and Aerococcus loyolae sp. nov. (ATCC TSD-300T = DSM 115698T = CCUG 76533T=NR-58628T) for three of the newly identified genomic taxa.
Collapse
Affiliation(s)
- Brian I Choi
- Loyola University Chicago, Department of Microbiology & Immunology, Maywood IL, USA
| | - Adriana Ene
- Loyola University Chicago, Bioinformatics Program, Chicago IL, USA
| | - Jingjie Du
- Loyola University Chicago, Department of Microbiology & Immunology, Maywood IL, USA
| | | | - Catherine Putonti
- Loyola University Chicago, Department of Microbiology & Immunology, Maywood IL, USA
- Loyola University Chicago, Bioinformatics Program, Chicago IL, USA
- Loyola University Chicago, Department of Biology, Chicago IL, USA
| | - Christian H Schouw
- The Regional Department of Clinical Microbiology, Region Zealand, Denmark
| | - Rimtas Dargis
- The Regional Department of Clinical Microbiology, Region Zealand, Denmark
| | - Erik Senneby
- Lund University, Clinical Microbiology, Department of Translational Medicine, Lund, Sweden
| | - Jens J Christensen
- The Regional Department of Clinical Microbiology, Region Zealand, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alan J Wolfe
- Loyola University Chicago, Department of Microbiology & Immunology, Maywood IL, USA
| |
Collapse
|
3
|
Htwe SS, Inkster T. Epidemiology and urological pathogenic potential of Aerococcus species in greater Glasgow and Clyde (Descriptive study of Aerococcus urinae in blood culture and urinary samples: clinical importance and potential marker of urinary tract pathology). J Med Microbiol 2023; 72. [PMID: 37335077 DOI: 10.1099/jmm.0.001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Introduction. Aerococcus species in particular A. urinae are increasingly reported as causative agents of bacteraemia, urinary tract infection, sepsis, and endocarditis. We sought to establish the epidemiology of A. urinae in Glasgow hospitals and whether the presence of the organism in clinical isolates could be an indicator of undiagnosed urinary tract pathology.Hypothesis/Gap statement. The knowledge gap among clinical staffs on Aerococcus species as emerging pathogens can be filled by understanding its epidemiology and clinical importance.Aim. Describe the epidemiology and clinical importance of Aerococcus urinae.Methodology. We reviewed positive blood cultures with Aerococcus species (2017-2021) and urinary isolates (2021) in Glasgow hospitals. Data were collected from clinical and laboratory database systems.Results. All 22 positive blood cultures were A. urinae and sensitive to amoxicillin, vancomycin, and ciprofloxacin. The median age was 80.5; the majority was male (18). In total, 15/22 (68 %) were diagnosed with urinary tract infection. Thirteen were treated with amoxicillin. No cases of infective endocarditis were noted. One patient was subsequently diagnosed with bladder carcinoma. All 83 positive urinary isolates in 72 patients were A. urinae. One was resistant to amoxicillin; two to ciprofloxacin; all sensitive to nitrofurantoin and vancomycin. The majority was female (43/83), the median age was 80. The commonest risk factors were underlying malignancy including bladder cancer (5/18), chronic kidney disease (17) and diabetes (16). Clinical data was unavailable in 24 episodes. Of these, 41/59 (69.5 %) were diagnosed with urinary tract infection. One patient was subsequently diagnosed with metastatic renal cancer while bladder wall lesions were identified in three patients, two of whom were waiting for an urology review at the time of study. Thirteen patients (18 %) had 1 year recurrent bacteriuria and three were not treated on initial episode.Conclusion. A. urinae are emerging pathogens and are likely to become more common due to advances in laboratory technologies and an ageing population. Clinical teams should be aware of their urological pathogenic potential and not dismiss them as contaminants. Whether Aerococcus infection is a potential indicator for undiagnosed urinary tract malignancy warrants further studies.
Collapse
Affiliation(s)
- Su Su Htwe
- NHS Greater Glasgow and Clyde, Department of Medical Microbiology, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow G31 2ER, UK
| | - Teresa Inkster
- NHS Greater Glasgow and Clyde, Department of Medical Microbiology, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow G31 2ER, UK
- Present address: NHS Greater Glasgow and Clyde, Department of Medical Microbiology, Queen Elizabeth University Hospital1345, Govan Road, Glasgow G51 4TF, UK
| |
Collapse
|
4
|
Angulo-López I, Fernández-Vecilla D, Aragón-Díez J, Lasa-Epelde L, Díaz-de-Tuesta JL. In vitro susceptibility of fosfomycin in Aerococcus spp. isolated from urine samples. Clin Microbiol Infect 2023:S1198-743X(23)00207-0. [PMID: 37179008 DOI: 10.1016/j.cmi.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/15/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Itziar Angulo-López
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain; Biocruces Bizkaia Health Research Institute, Barakaldo (Vizcaya), Spain.
| | - Domingo Fernández-Vecilla
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain; Biocruces Bizkaia Health Research Institute, Barakaldo (Vizcaya), Spain
| | - Julia Aragón-Díez
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain; Biocruces Bizkaia Health Research Institute, Barakaldo (Vizcaya), Spain
| | - Lourdes Lasa-Epelde
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain
| | - José Luis Díaz-de-Tuesta
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain; Biocruces Bizkaia Health Research Institute, Barakaldo (Vizcaya), Spain
| |
Collapse
|
5
|
Yee AC, Wong TTJ. Aero to the heart: A case of aortic valve endocarditis caused by Aerococcus Urinae in an elderly woman. IDCases 2023; 32:e01769. [PMID: 37128511 PMCID: PMC10148111 DOI: 10.1016/j.idcr.2023.e01769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023] Open
Abstract
Aerococcus urinae (A. urinae) is an infrequent cause of infective endocarditis (IE) and few cases have been reported especially in older women. As of this publication, there are 31 reported cases of IE caused by aerococcus urinae, and of these, 4 are of women, 3 of which are aged > 75 years. Here, we describe a case of A. urinae endocarditis in an 80-year-old woman presenting with worsening fatigue. A diagnosis of native aortic valve endocarditis was established based on characteristic findings of aortic valvular vegetation on transesophageal echocardiogram along with isolation of A. urinae on blood cultures.
Collapse
Affiliation(s)
- Aaron C. Yee
- Correspondence to: 506 6th St, Brooklyn, NY 11215, USA.
| | | |
Collapse
|
6
|
Geeraedts F, Stoffers C, Smidt H, Schijffelen M. Foul smelling urine in an adult caused by Aerococcus urinae. IDCases 2023; 31:e01657. [PMID: 36505906 DOI: 10.1016/j.idcr.2022.e01657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
We describe the first adult case with Aerococcus urinae positive urine cultures as the proven cause of recurrent socially disabling malodorous urine. Bacterial strain specific factors as well as host factors are shown to play a role. The condition can be resolved with proper antibiotics.
Collapse
|
7
|
Sihvonen R, Turunen M, Lehtola L, Pakarinen L, Grönroos JO, Rantakokko-Jalava K, Pätäri-Sampo A. Clinical and microbiological characterization of Aerococcus urinae bacteraemias at Helsinki metropolitan area, Finland. Eur J Clin Microbiol Infect Dis 2022; 41:751-60. [PMID: 35257275 DOI: 10.1007/s10096-022-04415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/31/2022] [Indexed: 12/03/2022]
Abstract
Our objective was to assess the incidence of bacteraemic Aerococcus urinae cases at Helsinki metropolitan area, Finland, from a 6-year study period (2013 to 2018) and to further characterize available cases. The study evaluates the outcome of commonly used cefuroxime treatment and determinate a set of A. urinae in vitro antimicrobial susceptibilities for benzylpenicillin, cefuroxime, and ceftriaxone. Clinical records of A. urinae bacteraemic patients were reviewed retrospectively. Antimicrobial susceptibility testing was performed by disk diffusion, gradient test, and broth microdilution for 139–141 clinical A. urinae isolates. Clinical data of 72/77 patients were combined with the in vitro susceptibilities. We found an increasing number of bacteraemic A. urinae cases within 6-year study period (p = 0.01). The patients were mainly elderly males, and all suffered from underlying conditions. A total of 27.3% of cases (21/77) showed polymicrobial blood cultures. Thirty-day mortality was 22.1%. Cefuroxime was the initial empiric antimicrobial agent given for 66/76 of the patients and treatment outcome was favorable for 20/22 patients who received cefuroxime at least up to day 5. All isolates were susceptible to benzylpenicillin and cefuroxime interpreted by EUCAST breakpoints for Aerococci and PK-PD breakpoints, respectively. MIC determinations gave variable results for ceftriaxone, 2.1–2.9% of the isolates were resistant. To conclude, it seems that the number of bacteraemic Aerococcus urinae cases is increasing at Helsinki metropolitan area, Finland, reflecting the growing blood culture sampling. Clinical A. urinae isolates were susceptible to cefuroxime in vitro. Treatment data indicate that empirical cefuroxime started for possibly urinary tract -derived community-acquired bacteraemia covers A. urinae.
Collapse
|
8
|
Ahmed Y, Bardia N, Judge C, Ahmad S, Malozzi C, Calderon E. Aerococcus urinae: A Rare Cause of Endocarditis Presenting With Acute Stroke. J Med Cases 2021; 12:65-70. [PMID: 34434432 PMCID: PMC8383606 DOI: 10.14740/jmc3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/25/2020] [Indexed: 11/11/2022] Open
Abstract
Aerococcus urinae is a rare organism infrequently isolated from cultures. Mostly known to cause urinary tract infection, it can cause bacteremia leading to severe urosepsis and infective endocarditis. Embolization is frequently reported with Aerococcus urinae endocarditis (AUE); hence, the presentation is highly variable. Sequelae such as various central nervous system manifestations, sepsis, valvular regurgitation with heart failure and even coronary artery involvement have been reported. We report a case of a 58-year-old man with AUE of the aortic valve, severe aortic regurgitation and embolic stroke as a result of embolization from AUE and ultimately required aortic valve replacement. Our case highlights this rare cause of endocarditis and offers insight into the variability of patient presentation and risk factors to consider.
Collapse
Affiliation(s)
- Yasir Ahmed
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Nikky Bardia
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Caleb Judge
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Sajjad Ahmad
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | | | - Eduardo Calderon
- Department of Infectious Diseases, University of South Alabama, Mobile, AL, USA
| |
Collapse
|
9
|
Roy FE, Berteau T, Bestman-Smith J, Grandjean Lapierre S, Dufresne SF, Domingo MC, Leduc JM. Validation of a Gradient Diffusion Method (Etest) for Testing of Antimicrobial Susceptibility of Aerococcus urinae to Fluoroquinolones. J Clin Microbiol 2021; 59:e0025921. [PMID: 34076476 DOI: 10.1128/JCM.00259-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aerococcus urinae is a urinary pathogen with well-described resistance to fluoroquinolones. This study aimed to validate the gradient diffusion (GD) method (Etest) on cation-adjusted Mueller-Hinton agar with 5% sheep blood for testing the susceptibilities of Aerococcus urinae to the antimicrobial agents ciprofloxacin and levofloxacin and to compare the Etest to the broth microdilution (BMD) method from CLSI document M45-A3. Agar dilution (AD), as recommended by EUCAST, was used as an alternative reference method to arbitrate discrepancies or address technical issues. Aerococcus urinae isolates from urinary specimens were prospectively collected between June 2016 and December 2017 from six hospitals in Quebec, Canada, and identifications were confirmed using Vitek MS with the IVD 3.0 database. Of the 207 isolates tested using BMD, 37 (17.9%) showed trailing and 19 (9.2%) showed insufficient growth; these were tested using AD. Also, 38 isolates (18.4%) for ciprofloxacin and 13 isolates (6.3%) for levofloxacin showed a lack of essential or categorical agreement between the Etest and BMD and were also tested by AD. By use of a combined reference method (BMD or AD), the susceptibility rates of Aerococcus urinae were 82.6% and 81.6% for ciprofloxacin and levofloxacin, respectively. Categorical agreement between GD and the combined reference methods was 95.2% for ciprofloxacin and 97.1% for levofloxacin, with no very major error identified. Major and minor error rates were 0.6% and 4.3% for ciprofloxacin and 1.2% and 1.9% for levofloxacin. Overall, antimicrobial susceptibility testing (AST) using the Etest on sheep blood agar showed good agreement with the reference methods and can be considered by clinical laboratories wishing to perform AST on Aerococcus urinae isolates.
Collapse
|
10
|
Tai DBG, Go JR, Fida M, Saleh OA. Management and treatment of Aerococcus bacteremia and endocarditis. Int J Infect Dis 2020; 102:584-589. [PMID: 33157289 DOI: 10.1016/j.ijid.2020.10.096] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES We describe our multicenter experience on diagnosis and management of Aerococcus bacteremia including the susceptibility profile of Aerococcus species and a suggested algorithm for clinicians. METHODS Retrospective study of all patients with positive blood cultures for Aerococcus species from January 2005 to July 2020 in our institution with clinical data and susceptibility profile. Data were collected from both electronic health record and clinical microbiology laboratory database. RESULTS There were 219 unique isolates with only the susceptibility profiles available, while 81 patients had clinical information available. Forty-nine of those cases were deemed as true bloodstream infection and the rest were of unclear clinical significance. Cases of endocarditis (n = 7) were high-grade, monomicrobial bacteremia caused by Aerococcus urinae. Patients with endocarditis were younger (66 vs 80 p < 0.05). The risk for endocarditis was higher if duration of symptoms was longer than 7 days (OR 105, 95% CI: 5-2271), or if there were septic emboli (OR 71, 95% CI: 3-1612). A DENOVA score cutoff of ≥ 3 was 100% sensitive and 89% specific in detecting endocarditis. The 30-day and 3-month all-cause mortality for bacteremia was 17% and 24%, respectively. Six out of seven patients with endocarditis survived. CONCLUSIONS Antibiotic regimen for aerococcal bloodstream infections and endocarditis should be guided by species identification and antimicrobial susceptibility testing. DENOVA scoring system's performance in this study is more congruent to other studies. Hence, it can be used as an adjunctive tool in assessing the need for echocardiogram to rule out endocarditis. In our experience, two and four weeks of treatment for bloodstream infections and endocarditis, respectively, had good outcomes.
Collapse
Affiliation(s)
| | - John Raymond Go
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, USA
| | - Madiha Fida
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, USA
| | - Omar Abu Saleh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, USA
| |
Collapse
|
11
|
Varughese R, Mathew A, Chadha R, Kostka J, Regelmann D. Prosthetic valve endocarditis caused by Aerococcus Urinae. IDCases 2020; 21:e00912. [PMID: 32884902 PMCID: PMC7452621 DOI: 10.1016/j.idcr.2020.e00912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 11/18/2022] Open
Abstract
Infective endocarditis (IE) caused by Aerococcus urinae is rare. The true incidence rate of this pathogen is likely underestimated as this is easily misidentified as Staphylococci or Streptococci. It is also associated with increased risk of complications such as systemic emboli. Aerococcus usually affects elderly males with underlying urological conditions. Here we present a case of IE with this rare Aerococcus urinae in a young man with a bioprosthetic aortic valve, despite negative urine cultures.
Collapse
Affiliation(s)
- Reba Varughese
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/St. Vincent’s Medical Center, Bridgeport, CT, USA
- Corresponding author.
| | - Achsah Mathew
- Pushpagiri Institute of Medical Sciences and Research Centre, Medicine, Tiruvalla, Kerala, India
| | - Rishi Chadha
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Julia Kostka
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - David Regelmann
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/St. Vincent’s Medical Center, Bridgeport, CT, USA
| |
Collapse
|
12
|
Lyagoubi A, Souffi C, Baroiller V, Vallee E. Aerococcus Urinae Spondylodiscitis: An Increasingly Described Localization. EJIFCC 2020; 31:169-173. [PMID: 32549885 PMCID: PMC7294815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aerococcus urinae is currently more frequently identified since the introduction of MALDI-TOF MS technique in routine laboratories. Serious infections such as endocarditis and spondylodiscitis are increasingly reported in the literature. This is a case of septic spondylodiscitis and bacteremia due to Aerococcus urinae with a urinary starting point.
Collapse
Affiliation(s)
- Amina Lyagoubi
- Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Chahrazad Souffi
- Department of Microbiology, Simone Veil Hospital, Eaubonne, Iles de France, France
| | - Victoria Baroiller
- Department of Physical Medicine and Rehabilitation, Simone Veil Hospital, Eaubonne, Iles de France, France
| | - Eric Vallee
- Department of Microbiology, Simone Veil Hospital, Eaubonne, Iles de France, France
| |
Collapse
|
13
|
Abstract
Background Aerococcus urinae is a Gram-positive coccus that is increasingly recognized as a urinary pathogen since the introduction of mass spectrometry for identification of bacteria. We report a case of abdominal aortitis (with aneurysm) caused by A urinae in a male with recurrent urinary tract infections and recently treated A urinae bacteremia. A 63-year-old gentleman with a history of A urinae urosepsis 7 weeks prior, presented to the Emergency Department with thoracolumbar back pain radiating bilaterally into the groin. Radiological and surgical findings were consistent with infective infrarenal aortitis with aneurysm. Methods The patient successfully underwent open surgical debridement and reconstruction of the infrarenal aorta with autologous vein graft. Results Aerococcus urinae was isolated from excised tissue. The patient completed a 4-week course of intravenous antimicrobial therapy. Conclusions Aurinae is a urinary pathogen with the ability to cause severe invasive disease including endovascular infections.
Collapse
Affiliation(s)
- Aakash Varun Chhibber
- Department of Microbiology, LabPLUS, Auckland District Health Board, Auckland, New Zealand
| | - Sharmini Muttaiyah
- Department of Microbiology, LabPLUS, Auckland District Health Board, Auckland, New Zealand
| | - Andrew A Hill
- Department of Vascular Surgery, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Sally A Roberts
- Department of Microbiology, LabPLUS, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
14
|
Forsvall A, Wagenius M, Rasmussen M. Perigenital necrotizing soft tissue infection caused by Aerococcus urinae. IDCases 2019; 18:e00590. [PMID: 31367520 PMCID: PMC6656800 DOI: 10.1016/j.idcr.2019.e00590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/27/2022] Open
Abstract
Aerococcus urinae can cause severe invasive infections emanating from the urinary tract especially in older males with comorbidities. Here we describe a case of an 80 year-old man with multiple comorbidities presenting with a peri-penile abscess and signs of severe infection. Upon incision A. urinae was isolated in pure culture and the infection was cured by a combination of drainage and antimicrobials. This case demonstrates the potential of A. urinae to cause severe soft tissue infections in predisposed individuals.
Collapse
Affiliation(s)
- Andreas Forsvall
- Lund University, Medical Faculty, Department for Clinical Sciences Lund, Division of Infection Medicine, Lund, Sweden
| | - Magnus Wagenius
- Lund University, Medical Faculty, Department for Clinical Sciences Lund, Division of Infection Medicine, Lund, Sweden
| | - Magnus Rasmussen
- Lund University, Medical Faculty, Department for Clinical Sciences Lund, Division of Infection Medicine, Lund, Sweden
| |
Collapse
|
15
|
Senneby E, Sunnerhagen T, Hallström B, Lood R, Malmström J, Karlsson C, Rasmussen M. Identification of two abundant Aerococcus urinae cell wall-anchored proteins. Int J Med Microbiol 2019; 309:151325. [PMID: 31257068 DOI: 10.1016/j.ijmm.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 06/16/2019] [Accepted: 06/23/2019] [Indexed: 02/06/2023] Open
Abstract
Aerococcus urinae is an emerging pathogen that causes urinary tract infections, bacteremia and infective endocarditis. The mechanisms through which A. urinae cause infection are largely unknown. The aims of this study were to describe the surface proteome of A. urinae and to analyse A. urinae genomes in search for genes encoding surface proteins. Two proteins, denoted Aerococcal surface protein (Asp) 1 and 2, were through the use of mass spectrometry based proteomics found to quantitatively dominate the aerococcal surface. The presence of these proteins on the surface was also shown using ELISA with serum from rabbits immunized with the recombinant Asp. These proteins had a signal sequence in the amino-terminal end and a cell wall-sorting region in the carboxy-terminal end, which contained an LPATG-motif, a hydrophobic domain and a positively charged tail. Twenty-three additional A. urinae genomes were sequenced using Illumina HiSeq technology. Six different variants of asp genes were found (denoted asp1-6). All isolates had either one or two of these asp-genes located in a conserved locus, designated Locus encoding Aerococcal Surface Proteins (LASP). The 25 genomes had in median 13 genes encoding LPXTG-proteins (range 6-24). For other Gram-positive bacteria, cell wall-anchored surface proteins with an LPXTG-motif play a key role for virulence. Thus, it will be of great interest to explore the function of the Asp proteins of A. urinae to establish a better understanding of the molecular mechanisms by which A. urinae cause disease.
Collapse
Affiliation(s)
- Erik Senneby
- Division of Infection Medicine, Department of Clinical Sciences, BMC B14, 221 85, Lund University, Lund, Sweden.
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, BMC B14, 221 85, Lund University, Lund, Sweden.
| | - Björn Hallström
- Centre for Translational Genomics, Division of Clinical Genetics, BMC B10, 221 85, Lund University, Lund, Sweden.
| | - Rolf Lood
- Division of Infection Medicine, Department of Clinical Sciences, BMC B14, 221 85, Lund University, Lund, Sweden.
| | - Johan Malmström
- Division of Infection Medicine, Department of Clinical Sciences, BMC B14, 221 85, Lund University, Lund, Sweden.
| | - Christofer Karlsson
- Division of Infection Medicine, Department of Clinical Sciences, BMC B14, 221 85, Lund University, Lund, Sweden.
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences, BMC B14, 221 85, Lund University, Lund, Sweden.
| |
Collapse
|
16
|
Yabes JM, Perdikis S, Graham DB, Markelz A. A rare case of Aerococcus urinae infective endocarditis in an atypically young male: case report and review of the literature. BMC Infect Dis 2018; 18:522. [PMID: 30333008 PMCID: PMC6191913 DOI: 10.1186/s12879-018-3414-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aerococcus urinae is a gram-positive, alpha-hemolytic coccus bacterium primarily implicated in less than 1 % of all symptomatic urinary tract infections. Risk factors for disease include male gender, advanced age, and comorbid genitourinary tract pathology. Infections beyond the genitourinary tract are rare, though spondylodiscitis, perineal abscesses, lymphadenitis, bacteremia, meningitis, and endocarditis have been reported. Less than fifty cases of A. urinae infective endocarditis (IE) have been described in the literature. The rare occurrence of A. urinae in human infections and resultant lack of randomized controlled trials have resulted in a significant degree of clinical uncertainty in the management of A. urinae IE. CASE PRESENTATION We present an unusual case of a forty-three year-old male with A. urinae infective endocarditis (IE) who was successfully treated with mitral valve replacement and six weeks of penicillin/gentamicin therapy. In addition, we include a comprehensive review of all reported cases of IE due to A. urinae with specific attention to therapeutic regimens and treatment durations. CONCLUSION Recent advances in diagnostic technology have led to an increase in the frequency A. urinae is diagnosed. Reviewing cases of Aerococcus urinae infections, their clinical courses and subsequent management can assist future healthcare providers and their patients.
Collapse
Affiliation(s)
- Joseph M Yabes
- Brooke Army Medical Center, Department of Infectious Disease, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA.
| | - Serafim Perdikis
- Brooke Army Medical Center, Department of Internal Medicine, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
| | - David B Graham
- Brooke Army Medical Center, Department of Cardiothoracic Surgery, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Ana Markelz
- Brooke Army Medical Center, Department of Infectious Disease, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
| |
Collapse
|
17
|
Greco M, Rúa-Figueroa Í, Ghiglione S, Santana Medina E, Quevedo Abeledo JC, Rodríguez-Lozano C. Musculoskeletal infections caused by Aerococcus urinae: a case-based review. Clin Rheumatol 2018; 37:2587-94. [PMID: 29574655 DOI: 10.1007/s10067-018-4072-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
Aerococcus are Gram-positive bacteria that have been historically misidentified using standard techniques. We report a case of a 63-year-old man with septic oligoarthritis caused by Aerococcus urinae (isolated in two ankle synovial fluid cultures and in two blood cultures). Due to the lack of evidence found in a search performed to identify similar cases, a systematic review was conducted with the objective to identify and analyze all documented cases of musculoskeletal infections caused by Aerococcus urinae. A total of 8 cases were selected: 6 spondylodiscitis, 1 periarticular hip abscess, and 1 prosthetic hip infection. Similarly, as in other Aerococcus urinae invasive infections, these were presented predominantly in older males with history of urinary tract disease, being identified mostly by sequencing of the 16S rRNA or by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), with an increasing incidence in the last years and generally with good sensitivity to beta-lactams (aminoglycosides were associated in some cases due to its synergistic effect). Additionally, 4 cases of musculoskeletal infections caused by Aerococcus viridans and 4 cases of Aerococcus urinae with ammoniacal and pervasive malodorous urine were identified; the last was a symptom also present in our case. In this review, we identify a recent increase of musculoskeletal infections caused by Aerococcus urinae, which as well as in series of other invasive infections could be well correlated with an increasing use of more sensible diagnosis methods in clinical laboratories. Therefore, we suggest that these probably will be more frequently diagnosed in the future.
Collapse
|
18
|
Adomavicius D, Bock M, Vahl CF, Siegel E. Aerococcus urinae Mitral Valve Endocarditis-Related Stroke: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2018; 6:2324709618758351. [PMID: 29511694 PMCID: PMC5833211 DOI: 10.1177/2324709618758351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/08/2018] [Accepted: 01/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background. Aerococcus urinae is a rare causative pathogen of infective endocarditis that results in a high risk of embolic events. The mortality rate for A urinae endocarditis is high. Old age and underlying urologic conditions are the best-known risk factors for infection. Case Description. We report the clinical course of the disease in a 49-year-old man who presented symptoms of a urinary tract infection. A few days later, transthoracic echocardiography showed a conspicuous mitral valve with myxomatous alterations. Following the detection of a cerebral embolism with associated stroke symptoms, as well as at the beginning of cardiac failure, the emergency indication for the surgical treatment of mitral valve endocarditis was given. On the second day following the operation, circulatory collapse rapidly developed. Following an unsuccessful attempt at cardiopulmonary resuscitation, the patient died. Review of the Literature. From 1991 to 2017, 29 cases of A urinae–induced endocarditis have been described in PubMed and Medline. One or 2 new cases are published annually. We review all reported cases of A urinae endocarditis, with an emphasis on the predisposing factors, course, and outcomes of the disease. Conclusion. A urinae endocarditis is a rare disease primarily affecting elderly men with urinary tract pathologies and comorbidities. The course of the disease is severe, and the outcome is often fatal. A 16S rDNA polymerase chain reaction investigation of bacterial genome provides proof of the presence of A urinae. Because of the high risk of embolism, rapid treatment should focus on the diseased heart valve. Based on existing data and the experience gained from handling cases, treatment with β-lactam and aminoglycosides is recommended. It is also recommended that operative therapy take place as soon as possible.
Collapse
Affiliation(s)
- Darius Adomavicius
- University Medical Centre Mainz, Mainz, Germany
- Darius Adomavicius, Department of Cardiac Surgery, University Medical Centre Mainz, Langenbeckstr 1, Mainz 55131, Germany.
| | - Mark Bock
- Helios Dr Horst Schmidt Clinics Wiesbaden, Wiesbaden, Germany
| | | | | |
Collapse
|
19
|
Carkaci D, Nielsen XC, Fuursted K, Skov R, Skovgaard O, Trallero EP, Lienhard R, Åhman J, Matuschek E, Kahlmeter G, Christensen JJ. Aerococcus urinae and Aerococcus sanguinicola: Susceptibility Testing of 120 Isolates to Six Antimicrobial Agents Using Disk Diffusion (EUCAST), Etest, and Broth Microdilution Techniques. Open Microbiol J 2017; 11:160-166. [PMID: 29151992 PMCID: PMC5676010 DOI: 10.2174/1874285801711010160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/03/2017] [Accepted: 08/13/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aerococcus urinae and Aerococcus sanguinicola are relatively newcomers and emerging organisms in clinical and microbiological practice. Both species have worldwide been associated with urinary tract infections. More rarely cases of bacteremia/septicemia and infective endocarditis have been reported. Treatment options are therefore important. Just recently, European recommendations on susceptibility testing and interpretive criteria have been released. OBJECTIVE In this investigation 120 A. urinae and A. sanguinicola isolates were tested for susceptibility to six antimicrobial agents: Penicillin, cefotaxime, meropenem, vancomycin, linezolid, and rifampicin. METHODS Three susceptibility testing methods were used; disk diffusion according to The European Committee on Antimicrobial Susceptibility Testing (EUCAST) standardized disk diffusion methodology and MIC determination with Etest and broth microdilution (BMD). All testing was performed with EUCAST media for fastidious organisms. RESULTS Data obtained in this study were part of the background data for establishing EUCAST breakpoints. MIC values obtained by Etest and BMD were well correlated with disk diffusion results. CONCLUSION All isolates were found susceptible to all six antimicrobial agents: penicillin, cefotaxime, meropenem, vancomycin, linezolid, and rifampicin.
Collapse
Affiliation(s)
- Derya Carkaci
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
- Department of Microbiology and Infection Control, Reference Laboratory Statens Serum Institut, Copenhagen, Denmark
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Xiaohui C. Nielsen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Kurt Fuursted
- Department of Microbiology and Infection Control, Reference Laboratory Statens Serum Institut, Copenhagen, Denmark
| | - Robert Skov
- Department of Microbiology and Infection Control, Reference Laboratory Statens Serum Institut, Copenhagen, Denmark
| | - Ole Skovgaard
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Emilio P. Trallero
- Department of Microbiology, Hospital Universitario Donostia, San Sebastián, Spain
| | | | - Jenny Åhman
- EUCAST Development Laboratory, Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Erika Matuschek
- EUCAST Development Laboratory, Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Gunnar Kahlmeter
- EUCAST Development Laboratory, Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Jens J. Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
20
|
Carkaci D, Højholt K, Nielsen XC, Dargis R, Rasmussen S, Skovgaard O, Fuursted K, Andersen PS, Stegger M, Christensen JJ. Genomic characterization, phylogenetic analysis, and identification of virulence factors in Aerococcus sanguinicola and Aerococcus urinae strains isolated from infection episodes. Microb Pathog 2017; 112:327-340. [PMID: 28943151 DOI: 10.1016/j.micpath.2017.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
Abstract
Aerococcus sanguinicola and Aerococcus urinae are emerging pathogens in clinical settings mostly being causative agents of urinary tract infections (UTIs), urogenic sepsis and more seldomly complicated infective endocarditis (IE). Limited knowledge exists concerning the pathogenicity of these two species. Eight clinical A. sanguinicola (isolated from 2009 to 2015) and 40 clinical A. urinae (isolated from 1984 to 2015) strains from episodes of UTIs, bacteremia, and IE were whole-genome sequenced (WGS) to analyze genomic diversity and characterization of virulence genes involved in the bacterial pathogenicity. A. sanguinicola genome sizes were 2.06-2.12 Mb with 47.4-47.6% GC-contents, and 1783-1905 genes were predicted whereof 1170 were core-genes. In case of A. urinae strains, the genome sizes were 1.93-2.44 Mb with 41.6-42.6% GC-contents, and 1708-2256 genes of which 907 were core-genes. Marked differences were observed within A. urinae strains with respect to the average genome sizes, number and sequence identity of core-genes, proteome conservations, phylogenetic analysis, and putative capsular polysaccharide (CPS) loci sequences. Strains of A. sanguinicola showed high degree of homology. Phylogenetic analyses showed the 40 A. urinae strains formed two clusters according to two time periods: 1984-2004 strains and 2010-2015 strains. Genes that were homologs to virulence genes associated with bacterial adhesion and antiphagocytosis were identified by aligning A. sanguinicola and A. urinae pan- and core-genes against Virulence Factors of Bacterial Pathogens (VFDB). Bacterial adherence associated gene homologs were present in genomes of A. sanguinicola (htpB, fbpA, lmb, and ilpA) and A. urinae (htpB, lap, lmb, fbp54, and ilpA). Fifteen and 11-16 CPS gene homologs were identified in genomes of A. sanguinicola and A. urinae strains, respectively. Analysis of these genes identified one type of putative CPS locus within all A. sanguinicola strains. In A. urinae genomes, five different CPS loci types were identified with variations in CPS locus sizes, genetic content, and structural organization. In conclusion, this is the first study dealing with WGS and comparative genomics of clinical A. sanguinicola and A. urinae strains from episodes of UTIs, bacteremia, and IE. Gene homologs associated with antiphagocytosis and bacterial adherence were identified and genetic variability was observed within A. urinae genomes. These findings contribute with important knowledge and basis for future molecular and experimental pathogenicity study of UTIs, bacteremia, and IE causing A. sanguinicola and A. urinae strains.
Collapse
Affiliation(s)
- Derya Carkaci
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Science and Environment, Roskilde University, Roskilde, Denmark; Department of Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - Katrine Højholt
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Bio and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark.
| | | | - Rimtas Dargis
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark.
| | - Simon Rasmussen
- Department of Bio and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark.
| | - Ole Skovgaard
- Department of Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Kurt Fuursted
- Department of Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - Paal Skytt Andersen
- Department of Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark; Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Marc Stegger
- Department of Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - Jens Jørgen Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
21
|
Meletis G, Chatzidimitriou D, Tsingerlioti F, Chatzopoulou F, Tzimagiorgis G. An initially unidentified case of urinary tract infection due to Aerococcus urinae. New Microbiol 2017; 40:221-222. [PMID: 28513811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
Aerococcus urinae is a microorganism responsible for urinary tract and blood stream infections which are rarely reported in clinical practice. However, it has been proposed that the infrequency of such reports may be partially due to difficulties related to pathogen identification. We present here a case of an elderly male patient with urinary tract infection where A. urinae was initially not identified by a private microbiology laboratory. Our report highlights the need to consider A. urinae as a causative agent of urinary tract infections because if not identified and properly treated it may lead to endocarditis or septicemia.
Collapse
Affiliation(s)
| | - Dimitrios Chatzidimitriou
- Labnet laboratories, Thessaloniki, Greece
- Laboratory of Microbiology, Medical School, Aristotle University of Thessaloniki, Greece
| | | | | | - Georgios Tzimagiorgis
- Laboratory of Biological Chemistry, School of Health Sciences, Medical Department, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
22
|
Abstract
Introduction:Aerococcus urinae is a rare cause of infective endocarditis. Aerococcus is a gram positive cocci that is easily misidentified as Staphylococci or Streptococci. The true incidence rate of this pathogen is likely underestimated. Recent advances in laboratory diagnostic methods with matrix-associated laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) have lead to increased recognition of this pathogen in the clinical microbiology lab, and awareness as a cause of infective endocarditis in the infectious disease community. Case reports: Aerococcus usually affects males with underlying urinary tract conditions. Herein, we report a case of prosthetic aortic valve endocarditis caused by Aerococcus urinae. Discussion: Our patient was considered high risk for cardiac surgery and was treated successfully with intravenous antibiotics alone for six weeks. Conclusion: Infective endocarditis should be considered in all cases of Aerococcus bacteremia and appropriate diagnostic evaluations pursued. Abbreviations: AV: Aortic valve; IE: Infective endocarditis
Collapse
Affiliation(s)
- Harsha Tathireddy
- Department of Internal Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Sahitya Settypalli
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - John J Farrell
- Department of Internal Medicine, Division of Infectious Disease, OSF Saint Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| |
Collapse
|
23
|
Kim J, Hong SK, Kim M, Yong D, Lee K. MALDI-TOF-MS Fingerprinting Provides Evidence of Urosepsis caused by Aerococcus urinae. Infect Chemother 2017; 49:227-229. [PMID: 28608657 PMCID: PMC5620391 DOI: 10.3947/ic.2017.49.3.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/21/2016] [Indexed: 11/29/2022] Open
Abstract
Urosepsis due to Aerococcus urinae is rare in clinical settings with only a few of reported cases worldwide by 16S rRNA sequencing. Here we report a case of sepsis caused by A. urinae in a 86 year-old male with complicated urinary tract infection which was confirmed through peptide mass fingerprinting of matrix-assisted laser desorption ionization time of flight mass spectrometry.
Collapse
Affiliation(s)
- Jieun Kim
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kuk Hong
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Myungsook Kim
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Dongeun Yong
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
24
|
Skalidis T, Papaparaskevas J, Konstantinou D, Kapolou E, Falagas ME, Legakis N. Aerococcus urinae, a cause of cystitis with malodorous urine in a child: clinical and microbiological challenges. JMM Case Rep 2017; 4:e005083. [PMID: 28348806 PMCID: PMC5361636 DOI: 10.1099/jmmcr.0.005083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/08/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction. An infection of the lower urinary tract associated with an extremely unpleasant odour due to Aerococcus urinae in an otherwise healthy 5-year-old boy is described herein. Case presentation. Interestingly, imaging examination revealed the presence of a bladder diverticulum. Routine microbiological examination based on Gram staining, colony morphology and catalase reactivity suggested that the responsible pathogen could belong either to staphylococci, α-haemolytic streptococci or enterococci, which are more common urine isolates. Of note is that the VITEK 2 automated system could not identify the micro-organism. Susceptibility testing showed full sensitivity to β-lactam antibiotics and resistance to trimethoprim/sulfamethoxazole. The isolate was subjected to 16S rRNA gene sequence analysis because of its unusual characteristics. It was identified as A. urinae and the sequence was deposited in GenBank under the accession number KU207150. Conclusion.A. urinae should be considered as a causative agent of urinary-tract infection associated with malodorous urine.
Collapse
Affiliation(s)
- Tilemachos Skalidis
- Central Laboratories, IASO Gynecology, Maternity and Pediatric Hospital, Iaso Group Hospitals , Athens , Greece
| | - Josef Papaparaskevas
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Goudi , Athens , Greece
| | | | - Eleni Kapolou
- Central Laboratories, IASO Gynecology, Maternity and Pediatric Hospital, Iaso Group Hospitals , Athens , Greece
| | - Mathhew E Falagas
- Department of Medicine - Infectious Diseases, IASO Group Hospitals , Athens , Greece
| | - Nicholas Legakis
- Central Laboratories, IASO Gynecology, Maternity and Pediatric Hospital, Iaso Group Hospitals , Athens , Greece
| |
Collapse
|
25
|
Hirzel C, Hirzberger L, Furrer H, Endimiani A. Bactericidal activity of penicillin, ceftriaxone, gentamicin and daptomycin alone and in combination against Aerococcus urinae. Int J Antimicrob Agents 2016; 48:271-6. [PMID: 27451085 DOI: 10.1016/j.ijantimicag.2016.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/11/2016] [Accepted: 05/14/2016] [Indexed: 11/15/2022]
Abstract
Aerococcus urinae can cause severe infections (bacteraemia and endocarditis) that are associated with high mortality. However, data on the bactericidal and synergistic activity for clinically implemented antibiotics are scarce. Time-kill analyses were performed on two clinical isolates (AU1 and AU2) and the reference strain ATCC 700306 for penicillin (PG), ceftriaxone (CRO), gentamicin (GEN), daptomycin (DAP) and their combinations. AU1 and AU2 were CRO-resistant (MICs, 2 µg/mL) and ATCC 700306 was high-level GEN-resistant (MIC, 512 µg/mL), whereas all strains were PG- and DAP-susceptible (MICs, ≤0.125 and ≤1 µg/mL, respectively). CFU counts were determined at various time points from 0 to 48 h. All experiments were performed at 0.5×, 1×, 2× and 4× MIC. PG and CRO were not bactericidal for all strains, whereas DAP exhibited bactericidal activity at all concentrations for AU2 and ATCC 700306. The combination of PG or CRO with GEN was bactericidal for AU1 and AU2 at antibiotic concentrations ≥1× MIC. Bactericidal synergism was detected for PG or CRO combined with GEN in the two clinical isolates. PG plus CRO showed non-bactericidal synergism for ATCC 700306. DAP with GEN was synergistic at 1× MIC for AU1, whereas the killing activity of DAP was too pronounced to detect potential synergism in AU2. The combination of PG or CRO with GEN is synergistic and bactericidal. Moreover, these in vitro data suggest that DAP may represent a potential bactericidal treatment alternative against A. urinae. This finding could be important for the treatment of patients with a β-lactam allergy or renal insufficiency.
Collapse
Affiliation(s)
- Cédric Hirzel
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Poliklinik Trakt 2, CH-3010 Bern, Switzerland
| | - Lea Hirzberger
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Poliklinik Trakt 2, CH-3010 Bern, Switzerland; Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3010 Bern, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital (Inselspital), University of Bern, Poliklinik Trakt 2, CH-3010 Bern, Switzerland
| | - Andrea Endimiani
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, CH-3010 Bern, Switzerland.
| |
Collapse
|
26
|
Westmoreland K, Halstead DC, DuBose PV. Infectious Endocarditis in 49-Year-Old Man and Discussion of Phenotypic Characteristics of Aerococcus urinae and Viridans Streptococci. Lab Med 2016; 45:e101-3. [PMID: 25135044 DOI: 10.1309/lmvroda352wdouyz] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PATIENT 49 year-old man. CHIEF COMPLAINT Dyspnea at rest and dyspnea on exertion. HISTORY OF PRESENT ILLNESS Diagnosed with upper respiratory tract infection 10 days previously. PAST MEDICAL HISTORY Obese (BMI not available), but no significant past medical history. SOCIAL HISTORY Noncontributory. FAMILY HISTORY Noncontributory.
Collapse
Affiliation(s)
| | | | - Patricia V DuBose
- Medical Laboratory Science-Department of Biology, University of North Florida Jacksonville Pathology Consultants, PA Baptist Health, Jacksonville, Florida
| |
Collapse
|
27
|
Siddiqui B, Chaucer B, Chevenon M, Fernandes D, Rana M, Nfonoyim J. Aerococcus urinae associated aortic and tricuspid valve infective endocarditis. IDCases 2016; 4:30-1. [PMID: 27051583 PMCID: PMC4802665 DOI: 10.1016/j.idcr.2016.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 12/01/2022] Open
Abstract
Aerococcus urinae is a rare bacteria usually associated with urinary tract infection. It is unusually associated with endocarditis. To date only 18 cases have been reported. Among these cases, the majority had aortic valve involvement. Three had mitral and aortic valve involvement, and two had mitral and tricuspid valve involvement. We present the first reported case of A. urinae associated aortic and tricuspid valve endocarditis. Timely recognition and appropriate treatment of this fatal infection is essential to decrease morbidity and mortality.
Collapse
Affiliation(s)
- Beenish Siddiqui
- Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, United States
| | - Benjamin Chaucer
- Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, United States
| | - Marie Chevenon
- Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, United States
| | - Denise Fernandes
- Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, United States
| | - Madhvi Rana
- Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, United States
| | - Jay Nfonoyim
- Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, United States
| |
Collapse
|
28
|
Sunnerhagen T, Nilson B, Olaison L, Rasmussen M. Clinical and microbiological features of infective endocarditis caused by aerococci. Infection 2015; 44:167-73. [PMID: 26119199 DOI: 10.1007/s15010-015-0812-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/13/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To define the clinical presentation of aerococcal infective endocarditis (IE) and the prevalence of synergy between penicillin and gentamicin on aerococcal isolates. METHODS Cases of aerococcal IE between 2002 and 2014 were identified in the Swedish Registry of Infective Endocarditis (SRIE). MALDI-TOF MS was used to confirm species determination. The medical records were analysed and compared to cases reported to the SRIE caused by other pathogens. RESULTS Sixteen cases of aerococcal IE, fourteen with Aerococcus urinae and two with Aerococcus sanguinicola, were confirmed. Etest-based methods and time-kill experiments suggested synergy between penicillin and gentamicin towards seven of fifteen isolates. The patients with aerococcal IE were significantly older than those with streptococci or Staphylococcus aureus IE. Most of the patients had underlying urinary tract diseases or symptoms suggesting a urinary tract focus of the infection. Seven patients with aerococcal IE presented with severe sepsis but ICU treatment was needed only in one patient and there was no fatality. Valve exchange surgery was needed in four patients and embolization was seen in three patients. CONCLUSIONS This report is the largest on aerococcal IE and suggests that the prognosis is relatively favourable despite the fact that the patients are old and have significant comorbidities.
Collapse
Affiliation(s)
- Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Tornavägen 10, BMC B14, 221 84, Lund, Sweden
| | - Bo Nilson
- Clinical Microbiology, Labmedicin, Region Skåne, Lund, Sweden.,Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.,Swedish Registry of Infective Endocarditis, Swedish Society of Infectious Diseases, Gothenburg, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Tornavägen 10, BMC B14, 221 84, Lund, Sweden.
| |
Collapse
|
29
|
Abstract
Aerococcus urinae is an aerobic, alpha hemolytic gram positive coccus bacterium that grows in pairs or clusters. We report the first case of vertebral osteomyelitis due to A. urinae. This has not been previously reported in the literature.
Collapse
Affiliation(s)
- Michael Jerome
- Department of Graduate Medical Education, Seton Hall University, School of Health and Medical Sciences, New Jersey, United States ; Department of Infectious Disease, St. Michael's Medical Center, New Jersey, United States
| | - Jihad Slim
- Department of Graduate Medical Education, Seton Hall University, School of Health and Medical Sciences, New Jersey, United States ; Department of Infectious Disease, St. Michael's Medical Center, New Jersey, United States
| | - Raymund Sison
- Department of Graduate Medical Education, Seton Hall University, School of Health and Medical Sciences, New Jersey, United States ; Department of Infectious Disease, St. Michael's Medical Center, New Jersey, United States
| | - Randy Marton
- Department of Graduate Medical Education, Seton Hall University, School of Health and Medical Sciences, New Jersey, United States ; Department of Infectious Disease, St. Joseph Medical Center, New Jersey, United States
| |
Collapse
|
30
|
Senneby E, Petersson AC, Rasmussen M. Epidemiology and antibiotic susceptibility of aerococci in urinary cultures. Diagn Microbiol Infect Dis 2014; 81:149-51. [PMID: 25497460 DOI: 10.1016/j.diagmicrobio.2014.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/13/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Abstract
In this study, we present population-based data regarding the prevalence of aerococci in clinical urinary samples. During a 3-month period, all aerococcal isolates from urinary samples from 2 clinical microbiology laboratories were collected. We identified 64 Aerococcus urinae isolates and 40 Aerococcus sanguinicola isolates, which correlates with an incidence of 33 cases of aerococcal bacteriuria per 100,000 inhabitants per year. The median age was 83years for all patients with aerococcal bacteriuria, which was significantly higher than for patients with Escherichia coli or Enterococcus faecalis bacteriuria. Sex was almost equally distributed between men and women with aerococcal bacteriuria, whereas females dominated in E. coli bacteriuria. The aerococcal isolates displayed low MICs for ampicillin, cefalotin, mecillinam, and nitrofurantoin. Most A. sanguinicola isolates were resistant to ciprofloxacin, whereas most A. urinae isolates had low MICs. Clinical studies are needed to establish clinical breakpoints and optimal treatment.
Collapse
Affiliation(s)
- Erik Senneby
- Division of Laboratory Medicine, Department of Clinical Microbiology, Sölvegatan 23, 221 85, Lund, Sweden; Division of Infection Medicine, Department of Clinical Sciences, Lund University, BMC B14, Tornavägen 10, 221 84 Lund, Sweden.
| | - Ann-Cathrine Petersson
- Division of Laboratory Medicine, Department of Clinical Microbiology, Sölvegatan 23, 221 85, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, BMC B14, Tornavägen 10, 221 84 Lund, Sweden
| |
Collapse
|
31
|
Jost C, Breton B, Biran V, Khung S, Chekroune S, Bonacorsi S. First case of pregnant women bacteraemia and probable early-onset neonatal infection due to Aerococcus urinae. New Microbes New Infect 2015; 3:1-3. [PMID: 25755882 DOI: 10.1016/j.nmni.2014.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/29/2014] [Accepted: 11/05/2014] [Indexed: 11/23/2022] Open
|