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Wang D, Haley E, Luke N, Mathur M, Festa RA, Zhao X, Anderson LA, Allison JL, Stebbins KL, Diaz MJ, Baunoch D. Emerging and Fastidious Uropathogens Were Detected by M-PCR with Similar Prevalence and Cell Density in Catheter and Midstream Voided Urine Indicating the Importance of These Microbes in Causing UTIs. Infect Drug Resist 2023; 16:7775-7795. [PMID: 38148772 PMCID: PMC10750486 DOI: 10.2147/idr.s429990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction This study compared microbial compositions of midstream and catheter urine specimens from patients with suspected complicated urinary tract infections to determine if emerging and fastidious uropathogens are infecting the bladder or are contaminants. Methods Urine was collected by in-and-out catheter (n = 1000) or midstream voiding (n = 1000) from 2000 adult patients (≥60 years of age) at 17 DispatchHealth sites across 11 states. The two groups were matched by age (mean 81 years), sex (62.1% female, 37.9% male), and ICD-10-CM codes. Microbial detection was performed with multiplex polymerase chain reaction (M-PCR) with a threshold for "positive detection" ≥ 10,000 cells/mL for bacteria or any detection for yeast. Results were divided by sex. Results In females, 28 of 30 microorganisms/groups were found by both collection methods, while in males 26 of 30 were found by both. There were significant overlaps in the detection and densities of classical uropathogens including Escherichia coli, Enterococcus faecalis, and Klebsiella pneumoniae, as well as emerging uropathogens including Actinotignum schaalii and Aerococcus urinae. In females, detection rates were slightly higher in midstream voided compared to catheter-collected (p = 0.0005) urine samples, while males showed the opposite trend (p < 0.0001). More polymicrobial infections were detected in midstream voided compared to catheter-collected samples (64.4% vs 45.7%, p < 0.0001) in females but the opposite in males (35.6% vs 47.0%, p = 0.002). Discussion In-and-out catheter-collected and midstream voided urine specimens shared significant similarities in microbial detections by M-PCR, with some differences found for a small subset of organisms and between sexes. Conclusion Non-invasive midstream voided collection of urine specimens for microbial detection and identification in cases of presumed UTI does not result in significantly more contamination compared to in-and-out catheter-collected specimens. Additionally, organisms long regarded as contaminants should be reconsidered as potential uropathogens.
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Affiliation(s)
- Dakun Wang
- Department of Writing, Stat4Ward, Pittsburgh, PA, USA
| | - Emery Haley
- Department of Clinical Research, Pathnostics, Irvine, CA, USA
| | - Natalie Luke
- Department of Clinical Research, Pathnostics, Irvine, CA, USA
| | - Mohit Mathur
- Department of Medical Affairs, Pathnostics, Irvine, CA, USA
| | | | - Xinhua Zhao
- Department of Statistical Analysis, Stat4Ward, Pittsburgh, PA, USA
| | - Lori A Anderson
- L. Anderson Diagnostic Market Access Consulting, San Diego, CA, USA
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2
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Lotte L, Durand C, Chevalier A, Gaudart A, Cheddadi Y, Ruimy R, Lotte R. Acute Pyelonephritis with Bacteremia in an 89-Year-Old Woman Caused by Two Slow-Growing Bacteria: Aerococcus urinae and Actinotignum schaalii. Microorganisms 2023; 11:2908. [PMID: 38138052 PMCID: PMC10746031 DOI: 10.3390/microorganisms11122908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Aerococcus urinae is an aerobic Gram-positive coccus that grows as tiny alpha-hemolytic colonies. Actinotignum schaalii is a slow-growing facultative anaerobic Gram-positive rod. These bacteria are part of the urogenital microbiota of healthy patients, but can also be involved in urinary tract infections (UTIs), particularly in elderly men and young children. Because A. urinae and A. schaalii are fastidious and are difficult to identify with phenotypic methods, they are underestimated causes of UTIs. Their growth is slow and requires a blood-enriched medium incubated under an anaerobic or 5% CO2 atmosphere for 48 h and from 24 to 48 h for A. schaalii and A. urinae, respectively. Furthermore, accurate identification is only possible using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) or molecular-based methods. In rare cases, these bacteria can be responsible for invasive infections. We describe, here, an unusual case of bacteremic UTI caused by both A. schaalii and A. urinae in an 89-year-old woman. She presented with dyspnea, and bacteriuria was noted. This challenging clinical and microbiological diagnosis was made in our laboratory by Gram staining urine with a leucocyte count >50/μL and/or a bacterial count >14/μL urinary culture on a blood agar plate. After 10 days of antimicrobial treatment consisting of 2 g amoxicillin PO t.i.d., the patient was discharged with a complete clinical and biological recovery. A. schaalii and A. urinae are probably still underestimated causes of UTIs. Microbiologists could consider the presence of these two bacteria using appropriate culture and identification methods in cases where a positive direct examination of urine reveals small Gram-positive rods or cocci, where undocumented UTIs are present in elderly patients, but also where a urinary dipstick is negative for nitrites and is associated with leukocyturia.
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Affiliation(s)
- Laurène Lotte
- Department of Biology, Cannes General Hospital, 06400 Cannes, France;
| | - Claire Durand
- Department of Infectious Diseases, Nice University Hospital, 06003 Nice, France;
| | - Alicia Chevalier
- Department of Bacteriology, Nice University Hospital, 06003 Nice, France; (A.C.); (A.G.); (Y.C.); (R.R.)
- CHU de Nice, Université Côte d’Azur, 06000 Nice, France
- Inserm, C3M, Université Côte d’Azur, 06204 Nice, France
| | - Alice Gaudart
- Department of Bacteriology, Nice University Hospital, 06003 Nice, France; (A.C.); (A.G.); (Y.C.); (R.R.)
| | - Yousra Cheddadi
- Department of Bacteriology, Nice University Hospital, 06003 Nice, France; (A.C.); (A.G.); (Y.C.); (R.R.)
| | - Raymond Ruimy
- Department of Bacteriology, Nice University Hospital, 06003 Nice, France; (A.C.); (A.G.); (Y.C.); (R.R.)
- CHU de Nice, Université Côte d’Azur, 06000 Nice, France
- Inserm, C3M, Université Côte d’Azur, 06204 Nice, France
| | - Romain Lotte
- Department of Bacteriology, Nice University Hospital, 06003 Nice, France; (A.C.); (A.G.); (Y.C.); (R.R.)
- CHU de Nice, Université Côte d’Azur, 06000 Nice, France
- Inserm, C3M, Université Côte d’Azur, 06204 Nice, France
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3
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Lieu A, Mah J, Peirano G, Somayaji R, Church D. Microbiological Characterization of Actinotignum schaalii Strains Causing Invasive Infections during a Multiyear Period in a Large Canadian Health Care Region. Microbiol Spectr 2022; 10:e0344222. [PMID: 36409090 PMCID: PMC9769901 DOI: 10.1128/spectrum.03442-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
Abstract
Actinotignum schaalii is an underrecognized Gram-positive bacillus that is associated with urinary tract infections and cutaneous abscesses. The role of A. schaalii in invasive infections continues to be unappreciated because the bacteria can be isolated from a diverse spectrum of clinical specimens, ranging from being a single pathogen in urine and blood cultures to being deemed a colonizer in polymicrobial anaerobic cultures of sterile fluids and tissues. We conducted a microbiological analysis of clinical isolates obtained from 2012 through 2019. A total of 86 isolates were analyzed; 37 (43%) were from blood cultures, 35 (41%) were from deep wounds and abscesses, 6 (7%) were from urine samples, and the rest were recovered from peritoneal, kidney, and scrotal fluid samples. Urinary tract infections were clinically identified as the source of most cases of bacteremia, although no simultaneous urine cultures yielded positive results. The 16S rRNA gene sequences were available for 32 isolates (37%). Phylogenetic analysis revealed that AS.1/AS.2 strains caused a larger proportion of bloodstream infections (BSIs) (100% versus 52% [P = 0.01]) and trended toward a higher rate of hospitalization (91% versus 76% [P = 0.18]) but had a lower clindamycin MIC90 (0.12 versus >256 μg/mL). Our study emphasizes the emergence of A. schaalii as a pathogen in human urine samples, BSIs, and skin and soft tissue infections. It highlights the pitfalls of current laboratory methods in recovering and identifying this organism from clinical specimens, particularly urine samples. Phylogenetic analysis showed unique genotypic sequences for A. schaalii AS.1/AS.2 strains causing urosepsis, which requires further study to identify potential virulence factors. IMPORTANCE Actinotignum schaalii is an underrecognized Gram-positive bacillus due to its special growth requirements and prior phenotypic identification methods, and it is often mistaken as a contaminant. It has been associated with various clinical syndromes, from urinary tract infections to cutaneous infections. The widespread use of molecular diagnostic methods allowed for improved detection. However, its role in invasive infections remains underappreciated. We conducted a detailed microbiological analysis to improve our understanding of this organism's genotypic and phenotypic characteristics. Our results highlight the pitfalls of clinical laboratory recovery, particularly from urine cultures. Although most BSIs were caused by urinary tract infections, no simultaneous urine cultures identified A. schaalii, largely due to the failure of phenotypic methods to reliably isolate and identify this organism. Additionally, this is the first study demonstrating A. schaalii strains with differences in clinical and microbiological characteristics, raising the possibility of potential bacterial virulence factors contributing to invasive infections.
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Affiliation(s)
- Anthony Lieu
- Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jordan Mah
- Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gisele Peirano
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deirdre Church
- Section of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
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4
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Ramos ISP, Angulo-López I, Peña-Trigueros MDL, Tuesta-Del Arco JLDD. Usefulness of flow cytometry in the diagnosis of urinary tract infections caused by fastidious microorganisms: a case report of acute cystitis caused by Actinotignum schaalii. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:580-581. [PMID: 35787349 DOI: 10.1016/j.eimce.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Iris Sharon Pérez Ramos
- Servicio de Microbiología Clínica, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain; Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain.
| | - Itziar Angulo-López
- Servicio de Microbiología Clínica, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain; Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain.
| | | | - José Luis Díaz de Tuesta-Del Arco
- Servicio de Microbiología Clínica, Hospital Universitario Basurto, Bilbao, Bizkaia, Spain; Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain.
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5
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Mah J, Lieu A, Somayaji R, Church D. Characterizing Actinotignum schaalii infections in a large Canadian healthcare region. Future Microbiol 2022; 17:1353-1362. [PMID: 36169260 DOI: 10.2217/fmb-2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: We characterize the epidemiology of Actinotignum schaalii within a large Canadian region after implementation of improved identification methods. Patients & methods: Positive cultures for A. schaalii from a centralized microbiology laboratory in Canada were analyzed. Clinical data were retrieved through administrative databases and chart reviews. Primary outcome was incidence of A. schaalii infections; secondary outcomes included mortality, hospital admission and length of stay. Results & conclusions: 86 unique isolates were studied, 37 bloodstream infections (BSI) and 49 non-BSIs. Patients with BSIs were older with more comorbidities, with urinary tract infections implicated as the most frequent source; skin abscesses caused the most non-BSIs. Hospitalization and 90-day mortality was higher in the BSI group. A. schaalii is an important community-acquired pathogen with the potential to cause invasive infections.
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Affiliation(s)
- Jordan Mah
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada.,Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Anthony Lieu
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Ranjani Somayaji
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada.,Department of Microbiology, Immunology & Infectious Disease, University of Calgary, Calgary, AB T2N 2T9, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Deirdre Church
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada.,Department of Microbiology, Immunology & Infectious Disease, University of Calgary, Calgary, AB T2N 2T9, Canada.,Department of Pathology & Laboratory Medicine, University of Calgary, AB T2N 2T9, Canada
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6
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Legaria M, Barberis C, Famiglietti A, De Gregorio S, Stecher D, Rodriguez C, Vay C. Urinary tract infection caused by anaerobic bacteria. Utility of anaerobic urine culture. Anaerobe 2022; 78:102636. [DOI: 10.1016/j.anaerobe.2022.102636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/01/2022]
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7
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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.
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8
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Utilidad de la citometría de flujo en el diagnóstico de infecciones del tracto urinario por microorganismos exigentes: a propósito de un caso de cistitits aguda por Actinotignum schaalii. Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimc.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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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.
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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:
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10
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Jensen VVS, Dargis R, Nielsen XC, Wiese L, Christensen JJ. Actinotignum schaalii and Aerococcus urinae as Etiology of Infected Kidney Cyst: A Diagnostic Challenge. Open Microbiol J 2020. [DOI: 10.2174/1874434602014010247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The case presented here illustrates a sometimes complex disease presentation where interdisciplinary teamwork is essential. A 74-years-old woman with stable chronic obstructive pulmonary lung disease and a composite graft aortic valve implant was admitted to hospital with an episode of acute lower back pain combined with long-term fever. The final diagnoses of a left-sided, infected and radiologically evident kidney cyst caused by the urinary tract pathogens Actinotignum schaalii and Aerococcus urinae was established by the use of partial 16S/18S rRNA gene sequence analysis on kidney cyst drainage material taken after four weeks of relevant antibiotic therapy.
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11
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Gajdács M, Urbán E. The Pathogenic Role of Actinomyces spp. and Related Organisms in Genitourinary Infections: Discoveries in the New, Modern Diagnostic Era. Antibiotics (Basel) 2020; 9:E524. [PMID: 32824418 PMCID: PMC7459602 DOI: 10.3390/antibiotics9080524] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022] Open
Abstract
Actinomycosis is a chronic, suppurative, granulomatous infectious disease, caused by different species of Actinomyces bacteria. To date, 26 validly published Actinomyces species have been described as part of a normal human microbiota or from human clinical specimens. Due to the rapid spread of new, modern diagnostic procedures, 13 of 26 of these species have been described in this century and the Actinomycetaceae family has undergone several taxonomic revisions, including the introduction of many novel species termed Actinomyces-like organisms (ALOs). There is scarce data available on the role of these novel bacterial species in various infectious processes in human medicine. The aim of this review is to provide a comprehensive overview of Actinomyces and closely related organisms involved in human diseases-with a special focus on newly described species-in particular their role in genitourinary tract infections in females and males.
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Affiliation(s)
- Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Hungary;
- Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, 1089 Budapest, Hungary
| | - Edit Urbán
- Institute of Translational Medicine, Faculty of Medicine, University of Pécs, 7624 Pécs, Hungary
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12
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Panganiban CM, Gupta S. Actinotignum schaalii Abscess in a Patient with Common Variable Immunodeficiency. Pathogens 2020; 9:E494. [PMID: 32580346 PMCID: PMC7350303 DOI: 10.3390/pathogens9060494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
Actinotignum schaalii is an anaerobic, gram-positive commensal organism of the urogenital tract. A. schaalii typically causes urinary tract infections, predominantly in the elderly. Here, we describe the first case of A. schaalii infection presenting as cellulitis and abscess in a patient with common variable immunodeficiency. The patient was successfully treated with an incision and drainage and a prolonged antibiotic course. A. schaalii infection should be considered in sterile abscesses, and anaerobic cultures should be requested in the absence of positive routine cultures.
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Affiliation(s)
| | - Sudhir Gupta
- Division of Basic and Clinical Immunology, and Department of Pathology and Laboratory Medicine, University of California at Irvine, Irvine, CA 92660, USA;
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13
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Kotaskova I, Obrucova H, Malisova B, Videnska P, Zwinsova B, Peroutkova T, Dvorackova M, Kumstat P, Trojan P, Ruzicka F, Hola V, Freiberger T. Molecular Techniques Complement Culture-Based Assessment of Bacteria Composition in Mixed Biofilms of Urinary Tract Catheter-Related Samples. Front Microbiol 2019; 10:462. [PMID: 30949137 PMCID: PMC6435596 DOI: 10.3389/fmicb.2019.00462] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/21/2019] [Indexed: 11/26/2022] Open
Abstract
Urinary or ureteral catheter insertion remains one of the most common urological procedures, yet is considered a predisposing factor for urinary tract infection. Diverse bacterial consortia adhere to foreign body surfaces and create various difficult to treat biofilm structures. We analyzed 347 urinary catheter- and stent-related samples, treated with sonication, using both routine culture and broad-range 16S rDNA PCR followed by Denaturing Gradient Gel Electrophoresis and Sanger sequencing (PCR-DGGE-S). In 29 selected samples, 16S rRNA amplicon Illumina sequencing was performed. The results of all methods were compared. In 338 positive samples, from which 86.1% were polybacterial, 1,295 representatives of 153 unique OTUs were detected. Gram-positive microbes were found in 46.5 and 59.1% of catheter- and stent-related samples, respectively. PCR-DGGE-S was shown as a feasible method with higher overall specificity (95 vs. 85%, p < 0.01) though lower sensitivity (50 vs. 69%, p < 0.01) in comparison to standard culture. Molecular methods considerably widened a spectrum of microbes detected in biofilms, including the very prevalent emerging opportunistic pathogen Actinotignum schaalii. Using massive parallel sequencing as a reference method in selected specimens, culture combined with PCR-DGGE was shown to be an efficient and reliable tool for determining the composition of urinary catheter-related biofilms. This might be applicable particularly to immunocompromised patients, in whom catheter-colonizing bacteria may lead to severe infectious complications. For the first time, broad-range molecular detection sensitivity and specificity were evaluated in this setting. This study extends the knowledge of biofilm consortia composition by analyzing large urinary catheter and stent sample sets using both molecular and culture techniques, including the widest dataset of catheter-related samples characterized by 16S rRNA amplicon Illumina sequencing.
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Affiliation(s)
- Iva Kotaskova
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czechia.,Medical Genomics Research Group, CEITEC, Masaryk University, Brno, Czechia.,Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, Brno, Czechia
| | - Hana Obrucova
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czechia
| | - Barbora Malisova
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czechia
| | - Petra Videnska
- Research Centre for Toxic Compounds in the Environment, Masaryk University, Brno, Czechia
| | - Barbora Zwinsova
- Research Centre for Toxic Compounds in the Environment, Masaryk University, Brno, Czechia
| | - Tereza Peroutkova
- Institute of Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Milada Dvorackova
- Institute of Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Petr Kumstat
- Department of Urology, St. Anne's University Hospital, Brno, Czechia
| | - Pavel Trojan
- Department of Urology, St. Anne's University Hospital, Brno, Czechia
| | - Filip Ruzicka
- Institute of Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Veronika Hola
- Institute of Microbiology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Tomas Freiberger
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, Brno, Czechia.,Medical Genomics Research Group, CEITEC, Masaryk University, Brno, Czechia.,Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, Brno, Czechia
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14
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Hemenway AN, Christensen A, Schriever C. Treatment considerations for potential uropathogens detected by precision microbiological testing. Am J Health Syst Pharm 2018; 75:1775-1782. [PMID: 30404894 DOI: 10.2146/ajhp180208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The clinical and microbiological data for urinary tract infections (UTIs) for 6 organisms detected by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) at community health systems were examined. SUMMARY The use of precision microbiological diagnostic testing such as MALDI-TOF and real-time quantitative polymerase chain reaction has increased the ability to detect a wider spectrum of organisms. This has raised questions of the clinical relevance of infrequently encountered organisms, especially when cultured from urine. This article reviews clinical and microbiological data for UTIs for 6 organisms detected by MALDI-TOF at community health systems (Actinotignum schaalii, Chryseobacterium indologenes, Aerococcus urinae, Aerococcus sanguinicola, Corynebacterium riegelii, and Corynebacterium urealyticum). Since little information currently exists, most of the data associating the aforementioned organisms with UTIs were derived from case reports. Although these organisms are more readily identified using precision microbiological diagnostic testing methods, infection should not be assumed based on culture results alone since asymptomatic bacteriuria has been reported. Similar to more common urinary pathogens, clinical correlation is essential. To facilitate treatment, we provide a table of empirical options likely to achieve clinical success based on in vivo and in vitro data. If available, pathogen-specific susceptibility data should be used to direct therapy. CONCLUSION Clinical and microbiological data and potential treatment options were presented for 6 traditionally underrecognized organisms that are increasingly being found from urinary specimens. The treatment recommendations should be interpreted cautiously as they were devised through the use of very limited data.
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Affiliation(s)
- Alice N Hemenway
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Rockford, IL
| | - Alyssa Christensen
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Rockford, IL
| | - Christopher Schriever
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Rockford, IL
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15
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The Brief Case: An Unusual Cause of Infective Endocarditis after a Urological Procedure. J Clin Microbiol 2018; 56:56/7/e01400-17. [PMID: 29941525 DOI: 10.1128/jcm.01400-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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16
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Klein S, Nurjadi D, Horner S, Heeg K, Zimmermann S, Burckhardt I. Significant increase in cultivation of Gardnerella vaginalis, Alloscardovia omnicolens, Actinotignum schaalii, and Actinomyces spp. in urine samples with total laboratory automation. Eur J Clin Microbiol Infect Dis 2018; 37:1305-1311. [PMID: 29651616 PMCID: PMC6015101 DOI: 10.1007/s10096-018-3250-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/29/2018] [Indexed: 11/26/2022]
Abstract
While total laboratory automation (TLA) is well established in laboratory medicine, only a few microbiological laboratories are using TLA systems. Especially in terms of speed and accuracy, working with TLA is expected to be superior to conventional microbiology. We compared in total 35,564 microbiological urine cultures with and without incubation and processing with BD Kiestra TLA for a 6-month period each retrospectively. Sixteen thousand three hundred thirty-eight urine samples were analyzed in the pre-TLA period and 19,226 with TLA. Sixty-two percent (n = 10,101/16338) of the cultures processed without TLA and 68% (n = 13,102/19226) of the cultures processed with TLA showed growth. There were significantly more samples with two or more species per sample and with low numbers of colony forming units (CFU) after incubation with TLA. Regarding the type of bacteria, there were comparable amounts of Enterobacteriaceae in the samples, slightly less non-fermenting Gram-negative bacteria, but significantly more Gram-positive cocci, and Gram-positive rods. Especially Alloscardivia omnicolens, Gardnerella vaginalis, Actinomyces spp., and Actinotignum schaalii were significantly more abundant in the samples incubated and processed with TLA. The time to report was significantly lower in the TLA processed samples by 1.5 h. We provide the first report in Europe of a large number of urine samples processed with TLA. TLA showed enhanced growth of non-classical and rarely cultured bacteria from urine samples. Our findings suggest that previously underestimated bacteria may be relevant pathogens for urinary tract infections. Further studies are needed to confirm our findings.
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Affiliation(s)
- Sabrina Klein
- Department of Infectious Diseases, Medical Microbiology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Susanne Horner
- Department of Infectious Diseases, Medical Microbiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Heeg
- Department of Infectious Diseases, Medical Microbiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Zimmermann
- Department of Infectious Diseases, Medical Microbiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Irene Burckhardt
- Department of Infectious Diseases, Medical Microbiology, University Hospital Heidelberg, Heidelberg, Germany
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17
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Horton LE, Mehta SR, Aganovic L, Fierer J. Actinotignum schaalii Infection: A Clandestine Cause of Sterile Pyuria? Open Forum Infect Dis 2018; 5:ofy015. [PMID: 29450211 PMCID: PMC5808804 DOI: 10.1093/ofid/ofy015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/24/2018] [Indexed: 11/25/2022] Open
Abstract
Actinotignum schaalii is an underappreciated cause of urinary tract infections (UTIs) in older adults. The diagnosis may be missed due to difficulty isolating and identifying the organism. Complications can result because the organism is intrinsically resistant to 2 commonly used drugs to treat UTI, as illustrated by this case.
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Affiliation(s)
- Lucy E Horton
- Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, School of Medicine, San Diego, California
| | - Sanjay R Mehta
- Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, School of Medicine, San Diego, California
| | - Lejla Aganovic
- Department of Radiology, VA San Diego Healthcare System, San Diego, California
| | - Joshua Fierer
- Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, School of Medicine, San Diego, California
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18
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Ikeda M, Kobayashi T, Suzuki T, Wakabayashi Y, Ohama Y, Maekawa S, Takahashi S, Homma Y, Tatsuno K, Sato T, Okugawa S, Moriya K, Yotsuyanagi H. Propionimicrobium lymphophilum and Actinotignum schaalii bacteraemia: a case report. New Microbes New Infect 2017; 18:18-21. [PMID: 28491325 PMCID: PMC5412094 DOI: 10.1016/j.nmni.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/25/2017] [Accepted: 03/28/2017] [Indexed: 11/26/2022] Open
Abstract
Propionimicrobium lymphophilum is an anaerobic Gram-positive bacillus that exists in human skin and urinary tract. The pathogenicity is, however, not well known. Only two cases of urinary tract infection have been described recently. In the case presented here, the bacterium was isolated, concomitant with Actinotignum schaalii, from blood culture of a patient with fever and difficulty of urination. The bacteria were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA sequencing. The case was successfully treated with ampicillin/sulbactam.
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Affiliation(s)
- M Ikeda
- Department of Infectious Disease, The University of Tokyo Hospital, Tokyo, Japan.,Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - T Kobayashi
- Department of Infectious Disease, The University of Tokyo Hospital, Tokyo, Japan
| | - T Suzuki
- Department of Infectious Disease, The University of Tokyo Hospital, Tokyo, Japan
| | - Y Wakabayashi
- Department of Infectious Disease, The University of Tokyo Hospital, Tokyo, Japan
| | - Y Ohama
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - S Maekawa
- Department of Urology, The University of Tokyo Hospital, Tokyo, Japan
| | - S Takahashi
- Department of Urology, The University of Tokyo Hospital, Tokyo, Japan
| | - Y Homma
- Department of Urology, The University of Tokyo Hospital, Tokyo, Japan
| | - K Tatsuno
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - T Sato
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - S Okugawa
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - K Moriya
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - H Yotsuyanagi
- Department of Infectious Disease, The University of Tokyo Hospital, Tokyo, Japan
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19
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Munson E, Carroll KC. What's in a Name? New Bacterial Species and Changes to Taxonomic Status from 2012 through 2015. J Clin Microbiol 2017; 55:24-42. [PMID: 27795334 PMCID: PMC5228236 DOI: 10.1128/jcm.01379-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Technological advancements in fields such as molecular genetics and the human microbiome have resulted in an unprecedented recognition of new bacterial genus/species designations by the International Journal of Systematic and Evolutionary Microbiology Knowledge of designations involving clinically significant bacterial species would benefit clinical microbiologists in the context of emerging pathogens, performance of accurate organism identification, and antimicrobial susceptibility testing. In anticipation of subsequent taxonomic changes being compiled by the Journal of Clinical Microbiology on a biannual basis, this compendium summarizes novel species and taxonomic revisions specific to bacteria derived from human clinical specimens from the calendar years 2012 through 2015.
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Affiliation(s)
- Erik Munson
- College of Health Sciences, Marquette University, Milwaukee, Wisconsin, USA
| | - Karen C Carroll
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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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.
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21
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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.
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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
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