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Lamichhane J, Choi BI, Stegman N, Fontes Noronha M, Wolfe AJ. Macrolide Resistance in the Aerococcus urinae Complex: Implications for Integrative and Conjugative Elements. Antibiotics (Basel) 2024; 13:433. [PMID: 38786161 PMCID: PMC11117264 DOI: 10.3390/antibiotics13050433] [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: 04/13/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
The recognition of the Aerococcus urinae complex (AUC) as an emerging uropathogen has led to growing concerns due to a limited understanding of its disease spectrum and antibiotic resistance profiles. Here, we investigated the prevalence of macrolide resistance within urinary AUC isolates, shedding light on potential genetic mechanisms. Phenotypic testing revealed a high rate of macrolide resistance: 45%, among a total of 189 urinary AUC isolates. Genomic analysis identified integrative and conjugative elements (ICEs) as carriers of the macrolide resistance gene ermA, suggesting horizontal gene transfer as a mechanism of resistance. Furthermore, comparison with publicly available genomes of related pathogens revealed high ICE sequence homogeneity, highlighting the potential for cross-species dissemination of resistance determinants. Understanding mechanisms of resistance is crucial for developing effective surveillance strategies and improving antibiotic use. Furthermore, the findings underscore the importance of considering the broader ecological context of resistance dissemination, emphasizing the need for community-level surveillance to combat the spread of antibiotic resistance within the urinary microbiome.
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Affiliation(s)
- Jyoti Lamichhane
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL 60153, USA (M.F.N.)
| | - Brian I. Choi
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL 60153, USA (M.F.N.)
| | - Natalie Stegman
- Bioinformatics Program, Loyola University Chicago, Chicago, IL 60660, USA;
| | - Melline Fontes Noronha
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL 60153, USA (M.F.N.)
| | - Alan J. Wolfe
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL 60153, USA (M.F.N.)
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Sahuquillo-Arce J, Suárez-Urquiza P, Hernández-Cabezas A, Tofan L, Chouman-Arcas R, García-Hita M, Sabalza-Baztán O, Sellés-Sánchez A, Lozano-Rodríguez N, Martí-Cuñat J, López-Hontangas J. Actinotignum schaalii infection: Challenges in diagnosis and treatment. Heliyon 2024; 10:e28589. [PMID: 38590897 PMCID: PMC10999919 DOI: 10.1016/j.heliyon.2024.e28589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Actinotignum schaalii affects elderly people and is associated with individuals with urological-related predispositions, but can be found in a variety of locations, such as cutaneous, intraabdominal, genitourinary and surgical infections. Disseminated infections occur less frequently and are by and large related to urinary tract colonisation. This pathogen is often neglected due to growth requirements, especially in urinary tract infections. We present 107 Actinotignum schaalii isolated from genitourinary samples (80.4%), from skin and soft tissue infections (13.1%), from bone and deep tissue infection (4.7%) and from blood cultures (1.9%). The automated system Alfred 60/AST was paramount for the isolation of 77.6% of the UTI. All the isolates tested were susceptible to penicillin, ampicillin, linezolid, vancomycin, teicoplanin, rifampicin and tetracycline. In conclusion, we present a large series of Actinotignum schaalii infections. This pathogen is hard to isolate, and is resistant to commonly used empirical antimicrobials.
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Affiliation(s)
- J.M. Sahuquillo-Arce
- Servicio de Microbiología, Hospital Doctor Moliner, Serra, Spain
- Grupo de Investigación de Infecciones Respiratorias, IIS La Fe, Valencia, Spain
| | - P. Suárez-Urquiza
- Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A. Hernández-Cabezas
- Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - L. Tofan
- Servicio de Análisis Clínicos, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - R. Chouman-Arcas
- Servicio de Microbiología, Hospital Francesc de Borja, Gandia, Spain
| | - M. García-Hita
- Servicio de Microbiología, Hospital de la Vega Lorenzo Guirao, Cieza, Spain
| | - O. Sabalza-Baztán
- Servicio de Microbiología, Hospital General Universitari de Castelló, Castellón de la Plana, Spain
| | | | - N. Lozano-Rodríguez
- Servicio de Microbiología, Hospital General Universitari de Castelló, Castellón de la Plana, Spain
| | - J. Martí-Cuñat
- Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J.L. López-Hontangas
- Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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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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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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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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Sahra S, Jahangir A, Kandlakunta H, Glaser A. Actinotignum schaalii Caught for the Second Time in Fournier's Gangrene! Cureus 2021; 13:e13288. [PMID: 33728221 PMCID: PMC7955795 DOI: 10.7759/cureus.13288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Actinotignum schaalii, a Gram-positive rod residing in the urinary tract, is responsible for urinary tract infections and their complications including but not limited to bacteremia and sepsis. A. schaalii is increasingly being detected in body fluid specimens owing to advancements in PCR techniques. This report describes an interesting case of an adult diabetic patient managed for Fournier's gangrene. A. schaalii was detected in the PCR of his wound cultures. To the best of our knowledge, this is the second case of A. schaalii as the causative agent for Fournier's gangrene.
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Affiliation(s)
- Syeda Sahra
- Internal Medicine, Northwell Health, Staten Island, USA
| | | | | | - Allison Glaser
- Infectious Diseases, Northwell Health, Staten Island, USA
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Yu Y, Tsitrin T, Bekele S, Thovarai V, Torralba MG, Singh H, Wolcott R, Doerfert SN, Sizova MV, Epstein SS, Pieper R. Aerococcus urinae and Globicatella sanguinis Persist in Polymicrobial Urethral Catheter Biofilms Examined in Longitudinal Profiles at the Proteomic Level. BIOCHEMISTRY INSIGHTS 2019; 12:1178626419875089. [PMID: 31555049 PMCID: PMC6753514 DOI: 10.1177/1178626419875089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/13/2019] [Indexed: 11/27/2022]
Abstract
Aerococcus urinae (Au) and Globicatella sanguinis (Gs) are gram-positive bacteria belonging to the family Aerococcaceae and colonize the human immunocompromised and catheterized urinary tract. We identified both pathogens in polymicrobial urethral catheter biofilms (CBs) with a combination of 16S rDNA sequencing, proteomic analyses, and microbial cultures. Longitudinal sampling of biofilms from serially replaced catheters revealed that each species persisted in the urinary tract of a patient in cohabitation with 1 or more gram-negative uropathogens. The Gs and Au proteomes revealed active glycolytic, heterolactic fermentation, and peptide catabolic energy metabolism pathways in an anaerobic milieu. A few phosphotransferase system (PTS)-based sugar uptake and oligopeptide ABC transport systems were highly expressed, indicating adaptations to the supply of nutrients in urine and from exfoliating squamous epithelial and urothelial cells. Differences in the Au vs Gs metabolisms pertained to citrate lyase and utilization and storage of glycogen (evident only in Gs proteomes) and to the enzyme Xfp that degrades d-xylulose-5'-phosphate and the biosynthetic pathways for 2 protein cofactors, pyridoxal 6'-phosphate and 4'-phosphopantothenate (expressed only in Au proteomes). A predicted ZnuA-like transition metal ion uptake system was identified for Gs while Au expressed 2 LPXTG-anchored surface proteins, one of which had a predicted pilin D adhesion motif. While these proteins may contribute to fitness and virulence in the human host, it cannot be ruled out that Au and Gs fill a niche in polymicrobial biofilms without being the direct cause of injury in urothelial tissues.
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Affiliation(s)
- Yanbao Yu
- J. Craig Venter Institute, Rockville,
MD, USA
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Actinobaculum massiliense Proteome Profiled in Polymicrobial Urethral Catheter Biofilms. Proteomes 2018; 6:proteomes6040052. [PMID: 30544882 PMCID: PMC6314084 DOI: 10.3390/proteomes6040052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 01/28/2023] Open
Abstract
Actinobaculum massiliense, a Gram-positive anaerobic coccoid rod colonizing the human urinary tract, belongs to the taxonomic class of Actinobacteria. We identified A. massiliense as a cohabitant of urethral catheter biofilms (CB). The CBs also harbored more common uropathogens, such as Proteus mirabilis and Aerococcus urinae, supporting the notion that A. massiliense is adapted to a life style in polymicrobial biofilms. We isolated a clinical strain from a blood agar colony and used 16S rRNA gene sequencing and shotgun proteomics to confirm its identity as A. massiliense. We characterized this species by quantitatively comparing the bacterial proteome derived from in vitro growth with that of four clinical samples. The functional relevance of proteins with emphasis on nutrient import and the response to hostile host conditions, showing evidence of neutrophil infiltration, was analyzed. Two putative subtilisin-like proteases and a heme/oligopeptide transporter were abundant in vivo and are likely important for survival and fitness in the biofilm. Proteins facilitating uptake of xylose/glucuronate and oligopeptides, also highly expressed in vivo, may feed metabolites into mixed acid fermentation and peptidolysis pathways, respectively, to generate energy. A polyketide synthase predicted to generate a secondary metabolite that interacts with either the human host or co-colonizing microbes was also identified. The product of the PKS enzyme may contribute to A. massiliense fitness and persistence in the CBs.
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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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Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract. Microbiol Spectr 2017; 4. [PMID: 27227294 DOI: 10.1128/microbiolspec.uti-0012-2012] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Gram-positive bacteria are a common cause of urinary-tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI.
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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] [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.
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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.
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12
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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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Actinotignum (formerly Actinobaculum) schaalii: a review of MALDI-TOF for identification of clinical isolates, and a proposed method for presumptive phenotypic identification. Pathology 2016; 48:367-71. [PMID: 27131934 DOI: 10.1016/j.pathol.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 03/12/2016] [Accepted: 03/21/2016] [Indexed: 12/21/2022]
Abstract
Actinotignum schaalii is a recognised cause of urinary tract infection. Following a case of urosepsis, 20 isolates of A. schaalii were collected over an initial 18 month period from urine and blood culture. An additional 25 isolates were collected over the following 13 months. Actinotignum schaalii had likely been overlooked or dismissed as a contaminant in our laboratory prior to this study period. It grows slowly on blood agar with supplemental CO2 or anaerobically. It may not grow on MacConkey agar or chromogenic agars used for routine urine culture. Repeated attempts at identification by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) may be required as the optimal age of cultures for testing is unclear. Utilising its characteristic antibiogram may assist phenotypic identification of this organism which is otherwise difficult to distinguish from other actinomycetes.
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14
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Lee MY, Kim MH, Lee WI, Kang SY, Jeon YL. A Case of Sepsis in a 92-Year-Old Korean Woman Caused byAerococcus urinaeand Identified by Sequencing the 16S Ribosomal RNA Gene. Lab Med 2016; 47:e15-7. [DOI: 10.1093/labmed/lmv030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Groah SL, Pérez-Losada M, Caldovic L, Ljungberg IH, Sprague BM, Castro-Nallar E, Chandel NJ, Hsieh MH, Pohl HG. Redefining Healthy Urine: A Cross-Sectional Exploratory Metagenomic Study of People With and Without Bladder Dysfunction. J Urol 2016; 196:579-87. [PMID: 26807926 DOI: 10.1016/j.juro.2016.01.088] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE We used the PathoScope platform to perform species level analyses of publicly available, 16S rRNA pyrosequenced, asymptomatic urine data to determine relationships between microbiomes, and clinical and functional phenotypes. MATERIALS AND METHODS We reanalyzed previously reported, cross-sectionally acquired urine samples from 47 asymptomatic subjects, including 23 controls and 24 subjects with neuropathic bladder. Urine was originally collected by the usual method of bladder drainage and analyzed by urinalysis, culture and pyrosequencing. Urinalysis and culture values were stratified as leukocyte esterase (0, or 1 or greater), nitrite (positive or negative), pyuria (fewer than 5, or 5 or greater white blood cells per high power field), cloudy urine (positive or negative) and urine culture bacterial growth (less than 50,000, or 50,000 or greater cfu/ml). PathoScope was used for next generation sequencing alignment, bacterial classification and microbial diversity characterization. RESULTS Subjects with neuropathic bladder were significantly more likely to have positive leukocyte esterase and pyuria, cloudy urine and bacterial growth. Of 47 samples 23 showed bacterial growth on culture and in all samples bacteria were identified by pyrosequencing. Nonneuropathic bladder urine microbiomes included greater proportions of Lactobacillus crispatus in females and Staphylococcus haemolyticus in males. The Lactobacillus community differed significantly among females depending on bladder function. Irrespective of gender the subjects with neuropathic bladder had greater proportions of Enterococcus faecalis, Proteus mirabilis and Klebsiella pneumonia. In 4 subjects with neuropathic bladder Actinobaculum sp. was detected by sequencing and by PathoScope but not by cultivation and in all cases it was associated with pyuria. CONCLUSIONS Using PathoScope plus 16S pyrosequencing we were able to identify unique, phenotype dependent, species level microbes. Novel findings included absent L. crispatus in the urine of females with neuropathic bladder and the presence of Actinobaculum only in subjects with neuropathic bladder.
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Affiliation(s)
- Suzanne L Groah
- MedStar National Rehabilitation Hospital, Washington, D.C.; Department of Rehabilitation Medicine, Georgetown University Hospital, Washington, D.C..
| | - Marcos Pérez-Losada
- Department of Integrative Systems Biology, Children's National Health System, Washington, D.C.; Computational Biology Institute, George Washington University, Ashburn, Virginia; CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, Portugal
| | - Ljubica Caldovic
- Department of Integrative Systems Biology, Children's National Health System, Washington, D.C
| | | | - Bruce M Sprague
- Division of Urology, Children's National Health System, Washington, D.C
| | - Eduardo Castro-Nallar
- Computational Biology Institute, George Washington University, Ashburn, Virginia; Center for Bioinformatics and Integrative Biology, Facultad de Ciencias Biológicas, Universidad Andres Bello, Santiago, Chile
| | - Neel J Chandel
- MedStar National Rehabilitation Hospital, Washington, D.C
| | - Michael H Hsieh
- Division of Urology, Children's National Health System, Washington, D.C
| | - Hans G Pohl
- Division of Urology, Children's National Health System, Washington, D.C
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16
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Lotte R, Lotte L, Ruimy R. Actinotignum schaalii (formerly Actinobaculum schaalii): a newly recognized pathogen-review of the literature. Clin Microbiol Infect 2015; 22:28-36. [PMID: 26577137 DOI: 10.1016/j.cmi.2015.10.038] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022]
Abstract
The genus Actinotignum contains three species, Actinotignum schaalii (formerly Actinobaculum schaalii), Actinotignum urinale and Actinotignum sanguinis. A. schaalii is the species most frequently involved in human infections, with 172 cases, mostly urinary tract infections (UTIs), reported so far. Invasive infections have also been described. This facultative anaerobic Gram-positive rod is part of the urinary microbiota of healthy patients. It is responsible for UTIs, particularly in elderly men and young children. A. schaalii is an underestimated cause of UTIs because of its fastidious growth on usual media and difficulties associated with its identification using phenotypic methods. Indeed, this slow-growth bacterium requires blood-enriched media and an incubation time of 48 hours under anaerobic or 5% CO2 atmosphere. Furthermore, only matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) or molecular-based methods allow the accurate identification of this bacteria. MALDI-TOF using Microflex LT with the Biotyper database (Bruker Daltonics, Bremen, Germany) is the most reliable technology for the routine identification of A. schaalii. The identification of this uropathogen is all the more important because it is resistant to trimethoprim/sulfamethoxazole and second-generation quinolones that are widely used in the treatment of UTIs. Antimicrobial therapy using β-lactams prolonged for up to 2 weeks is the most efficient treatment and should be recommended. Microbiologists should assess the presence of A. schaalii in urine using appropriate culture and identification methods in the case of a direct examination that is positive for small coccoid rods, a negative nitrite urinary stick associated with leukocyturia, treatment failure with trimethoprim/sulfamethoxazole or fluoroquinolones, or undocumented, repeated UTIs.
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Affiliation(s)
- R Lotte
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France; INSERM U1065 (C3M), Bacterial Toxins in Host Pathogen Interactions, C3M, Bâtiment Universitaire Archimed, Nice, France.
| | - L Lotte
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France
| | - R Ruimy
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France; INSERM U1065 (C3M), Bacterial Toxins in Host Pathogen Interactions, C3M, Bâtiment Universitaire Archimed, Nice, France
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17
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Abstract
Actinomyces israelii has long been recognized as a causative agent of actinomycosis. During the past 3 decades, a large number of novel Actinomyces species have been described. Their detection and identification in clinical microbiology laboratories and recognition as pathogens in clinical settings can be challenging. With the introduction of advanced molecular methods, knowledge about their clinical relevance is gradually increasing, and the spectrum of diseases associated with Actinomyces and Actinomyces-like organisms is widening accordingly; for example, Actinomyces meyeri, Actinomyces neuii, and Actinomyces turicensis as well as Actinotignum (formerly Actinobaculum) schaalii are emerging as important causes of specific infections at various body sites. In the present review, we have gathered this information to provide a comprehensive and microbiologically consistent overview of the significance of Actinomyces and some closely related taxa in human infections.
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18
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Le Brun C, Robert S, Tanchoux C, Bruyere F, Lanotte P. Urinary tract infection caused by Actinobaculum schaalii: a urosepsis pathogen that should not be underestimated. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cécile Le Brun
- Laboratoire de Bactériologie–Virologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| | - Sylvie Robert
- Laboratoire de Bactériologie–Virologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| | - Colas Tanchoux
- Service d'Urologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| | - Franck Bruyere
- Service d'Urologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
| | - Philippe Lanotte
- Laboratoire de Bactériologie–Virologie, CHRU de Tours, Hôpital Bretonneau, 37000 Tours, France
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Nienhouse V, Gao X, Dong Q, Nelson DE, Toh E, McKinley K, Schreckenberger P, Shibata N, Fok CS, Mueller ER, Brubaker L, Wolfe AJ, Radek KA. Interplay between bladder microbiota and urinary antimicrobial peptides: mechanisms for human urinary tract infection risk and symptom severity. PLoS One 2014; 9:e114185. [PMID: 25486068 PMCID: PMC4259481 DOI: 10.1371/journal.pone.0114185] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/05/2014] [Indexed: 12/11/2022] Open
Abstract
Resident bacterial communities (microbiota) and host antimicrobial peptides (AMPs) are both essential components of normal host innate immune responses that limit infection and pathogen induced inflammation. However, their interdependence has not been investigated in the context of urinary tract infection (UTI) susceptibility. Here, we explored the interrelationship between the urinary microbiota and host AMP responses as mechanisms for UTI risk. Using prospectively collected day of surgery (DOS) urine specimens from female pelvic floor surgery participants, we report that the relative abundance and/or frequency of specific urinary microbiota distinguished between participants who did or did not develop a post-operative UTI. Furthermore, UTI risk significantly correlated with both specific urinary microbiota and β-defensin AMP levels. Finally, urinary AMP hydrophobicity and protease activity were greater in participants who developed UTI, and correlated positively with both UTI risk and pelvic floor symptoms. These data demonstrate an interdependency between the urinary microbiota, AMP responses and symptoms, and identify a potential mechanism for UTI risk. Assessment of bacterial microbiota and host innate immune AMP responses in parallel may identify increased risk of UTI in certain populations.
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Affiliation(s)
- Vanessa Nienhouse
- The Burn and Shock Trauma Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Microbiology and Immunology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Xiang Gao
- Department of Biological Sciences, University of North Texas, Denton, Texas, United States of America
- Department of Computer Science and Engineering, University of North Texas, Denton, Texas, United States of America
| | - Qunfeng Dong
- Department of Biological Sciences, University of North Texas, Denton, Texas, United States of America
- Department of Computer Science and Engineering, University of North Texas, Denton, Texas, United States of America
| | - David E. Nelson
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Evelyn Toh
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kathleen McKinley
- Department of Pathology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Paul Schreckenberger
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Pathology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Noriko Shibata
- Department of Microbiology and Immunology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Cynthia S. Fok
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Obstetrics/Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Urology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Elizabeth R. Mueller
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Obstetrics/Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Urology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Linda Brubaker
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Obstetrics/Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Urology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Alan J. Wolfe
- Department of Microbiology and Immunology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
| | - Katherine A. Radek
- The Burn and Shock Trauma Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Microbiology and Immunology at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Stritch School of Medicine at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Infectious Disease and Immunology Research Institute at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- Department of Surgery at Loyola University Chicago, Health Sciences Division, Maywood, Illinois, United States of America
- * E-mail:
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20
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Hays C, Lienhard R, Auzou M, Barraud O, Guérin F, Ploy MC, Cattoir V. Erm(X)-mediated resistance to macrolides, lincosamides and streptogramins in Actinobaculum schaalii. J Antimicrob Chemother 2014; 69:2056-60. [PMID: 24710027 DOI: 10.1093/jac/dku099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Actinobaculum schaalii is a Gram-positive bacillus increasingly reported as a causative agent of urinary tract infections as well as invasive infections, mainly in the elderly and patients with underlying urological conditions. Since little is known about the molecular basis of antimicrobial resistance in A. schaalii, the aim of this study was to investigate resistance to macrolides, lincosamides and streptogramins (MLS) in this emerging pathogen. METHODS A total of 32 A. schaalii clinical isolates from France and Switzerland were studied. MICs of erythromycin, spiramycin, lincomycin, clindamycin and quinupristin/dalfopristin were determined by the agar dilution method. Resistance genes erm(A), erm(B), erm(C), erm(F), erm(G), erm(X), msr(A) and mef(A) were screened by PCR. The genetic environment was determined by random cloning and PCR mapping. RESULTS Out of 32 isolates tested, 21 were highly resistant to erythromycin, spiramycin, lincomycin and clindamycin (MICs >256 mg/L), whereas 11 exhibited low MICs (MICs < 0.12 mg/L). On the other hand, quinupristin/dalfopristin remained active against all the isolates. An inducible MLSB resistance phenotype was noted in all cases. The erm(X) gene was detected among all resistant strains, whereas none was detected in susceptible strains. Analysis of genetic support and environment revealed that erm(X) was probably part of the chromosome of A. schaalii. CONCLUSIONS This study is the first molecular characterization of MLS resistance in A. schaalii. In all cases, it was due to the presence of erm(X), a methylase gene previously identified in other clinically relevant Gram-positive bacilli.
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Affiliation(s)
| | | | - Michel Auzou
- CHU de Caen, Service de Microbiologie, Caen, France
| | - Olivier Barraud
- CHU de Limoges, Service de Bactériologie-Virologie-Hygiène, Limoges, France INSERM U1092, Limoges, France Université de Limoges, UMR-S1092, Limoges, France
| | - François Guérin
- CHU de Caen, Service de Microbiologie, Caen, France Université de Caen Basse-Normandie, EA4655 (équipe 'Antibio-résistance'), Caen, France
| | - Marie-Cécile Ploy
- CHU de Limoges, Service de Bactériologie-Virologie-Hygiène, Limoges, France INSERM U1092, Limoges, France Université de Limoges, UMR-S1092, Limoges, France
| | - Vincent Cattoir
- CHU de Caen, Service de Microbiologie, Caen, France Université de Caen Basse-Normandie, EA4655 (équipe 'Antibio-résistance'), Caen, France
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21
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Tuuminen T, Suomala P, Harju I. Actinobaculum schaalii: identification with MALDI-TOF. New Microbes New Infect 2014; 2:38-41. [PMID: 25356339 PMCID: PMC4184588 DOI: 10.1002/2052-2975.32] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
Actinobaculum schaalii is an emerging uropathogen. So far, its identification has been performed with 16S rRNA gene sequencing or PCR. The diagnosis has often been delayed due to fastidious growth and identification problems. Eleven clinical isolates of A. schaalii from bloodstream infections that were initially identified with 16S rRNA sequencing analysis were recovered and later identified with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF). We present a review of bacteriological data of these patients, an algorithm for fast laboratory work-up and advocate the use of sensitized culture of urine to allow better recovery of A. schaalii in susceptible patients.
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Affiliation(s)
- T Tuuminen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki Helsinki, Finland ; Eastern Finland Laboratory Centre Joint Authority Enterprise, Mikkeli District Laboratory Finland
| | - P Suomala
- Eastern Finland Laboratory Centre Joint Authority Enterprise, Mikkeli District Laboratory Finland
| | - I Harju
- Clinical Microbiology Laboratory, Turku University Hospital Turku, Finland
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22
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Aerococcus viridans native valve endocarditis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:155-8. [PMID: 24421827 DOI: 10.1155/2013/470413] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aerococcus viridans is an infrequent human pathogen and few cases of infective endocarditis have been reported. A case involving a 69-year-old man with colon cancer and hemicolectomy 14 years previously, without recurrence, is reported. A diagnosis of native mitral valve endocarditis was established on the basis of clinical presentation, characteristic echocardiographic findings and pathological specimen examination after urgent valve replacement. A viridans endocarditis appears to be particularly virulent, requiring a surgical approach in four of 10 cases reported and death in one of nine. Given the aggressive nature of A viridans endocarditis and the variable time to diagnosis (a few days to seven months), prompt recognition of symptoms and echocardiography, in addition to blood cultures, should be performed when symptoms persist.
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van Aarle S, Arents NLA, de Laet K. Actinobaculum schaalii causing epididymitis in an elderly patient. J Med Microbiol 2013; 62:1092-1093. [PMID: 23682167 DOI: 10.1099/jmm.0.048611-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Actinobaculum schaalii is a Gram-positive coccoid rod that causes various infections in humans and is easily overlooked in cultures. A. schaalii has long been thought to be of low prevalence and limited invasive potential, causing benign cystitis in elderly patients with underlying urological conditions. Here, we report the first case of epididymitis caused by this bacterium.
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Affiliation(s)
- S van Aarle
- Department of Urology, Maxima Medical Center, Veldhoven, The Netherlands
| | - N L A Arents
- Department of Microbiology, PAMM Foundation, Veldhoven, The Netherlands
| | - K de Laet
- Department of Urology, Maxima Medical Center, Veldhoven, The Netherlands
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24
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Torres-Sangiao E, Lissarrague-Sanz A, Cañizares-Castellanos A, Bou G. Prostatitis bacteriana. Enferm Infecc Microbiol Clin 2013; 31:344-6. [DOI: 10.1016/j.eimc.2012.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 11/26/2022]
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Olsen AB, Andersen PK, Bank S, Søby KM, Lund L, Prag J. Actinobaculum schaalii, a commensal of the urogenital area. BJU Int 2013; 112:394-7. [PMID: 23350855 DOI: 10.1111/j.1464-410x.2012.11739.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Actinobaculum schaalii is considered to be a part of the normai flora in the genital and urinary tract area. It has been associated to urinary tract infection (UTI), sepsis, osteomyelitis, endocarditis and Foumier's gangrene. So far it has mainly been isolated from urine, blood and pus, and predominantly in elderly patients. This study examined the habitat of A. schaalii by collecting samples from skin and urine in patients with kidney or ureter stones before and after treatment with Extracorporeal Shock Wave Lithotripsy (ESWL). Additionally faeces and vaginal swabs from routine specimen in patients not undergoing ESWL and without known urinary calculi were also analysed. The study does not find A. schaalii in faeces but shows it to be presents on skin and mucosa in the genital area. A. schaalii is also shown a possible pathogen in the stone-patient group undergoing ESWL. OBJECTIVE To study the habitat of Actinobaculum schaalii by examing groin swabs, faeces samples and vaginal swabs, and to determine whether it is a common uropathogen in patients with kidney or ureter stones. PATIENTS AND METHODS A quantitative real-time PCR assay was used to analyse all samples, which were collected between 2010 and 2011. A total of 38 patients (24 men and 14 women), with kidney or ureter stones and undergoing extracorporeal shock wave lithotripsy (ESWL), provided urine samples and had groin swabs taken. In addition, 30 faecal samples and 19 vaginal swabs that had been sent for routine microbiological examinations from patients outside the ESWL group were analysed. A chi-squared test was used to analyse the differences between patient groups, studying samples from urine, faeces samples, groin swabs and vaginal swabs. RESULTS Actinobaculum schaalii was found in the urine samples from 14 (37%) patients undergoing ESWL, and in both urine and groin swabs from seven (18%) patients. Actinobaculum schaalii was not found in faeces samples but it was found in six (32%) of the vaginal swabs, predominantly in patients >50 years (P = 0.06). CONCLUSION The study indicates that A. schaalii is a commensal found on skin, urine and vaginal mucosa in the human urogenital area and supports other investigations in its finding that the elderly are at greatest risk of being colonized with A. schaalii.
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Affiliation(s)
- Anne B Olsen
- Department of Urology, Viborg Hospital, Viborg, Denmark.
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26
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Zimmermann P, Berlinger L, Liniger B, Grunt S, Agyeman P, Ritz N. Actinobaculum schaalii an emerging pediatric pathogen? BMC Infect Dis 2012; 12:201. [PMID: 22928807 PMCID: PMC3457841 DOI: 10.1186/1471-2334-12-201] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 08/15/2012] [Indexed: 11/24/2022] Open
Abstract
Background Actinobaculum schaalii was first described as a causative agent for human infection in 1997. Since then it has mainly been reported causing urinary tract infections (UTI) in elderly individuals with underlying urological diseases. Isolation and identification is challenging and often needs molecular techniques. A. schaalii is increasingly reported as a cause of infection in humans, however data in children is very limited. Case presentation We present the case of an 8-month-old Caucasian boy suffering from myelomeningocele and neurogenic bladder who presented with a UTI. An ultrasound of the urinary tract was unremarkable. Urinalysis and microscopy showed an elevated leukocyte esterase test, pyuria and a high number of bacteria. Empiric treatment with oral co-trimoxazole was started. Growth of small colonies of Gram-positive rods was observed after 48 h. Sequencing of the 16S rRNA gene confirmed an A. schaalii infection 9 days later. Treatment was changed to oral amoxicillin for 14 days. On follow-up urinalysis was normal and urine cultures were negative. Conclusions A.schaalii is an emerging pathogen in adults and children. Colonization and subsequent infection seem to be influenced by the age of the patient. In young children with high suspicion of UTI who use diapers or in children who have known abnormalities of their urogenital tract, infection with A. schaalii should be considered and empiric antimicrobial therapy chosen accordingly.
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Affiliation(s)
- Petra Zimmermann
- Department of Paediatrics, University Children's Hospital, Berne, Switzerland
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Peltroche-Llacsahuanga H, Frye B, Haase G. Isolation of Streptococcus urinalis from a human blood culture. J Med Microbiol 2012; 61:740-742. [PMID: 22245791 DOI: 10.1099/jmm.0.039792-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Streptococcus urinalis was isolated from a blood culture of a 60-year-old man with a history of urethral stricture. This species has been recently described as a new member of the pyogenic subgroup of streptococci that cause urinary tract infections.
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Affiliation(s)
| | - Björn Frye
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Gerhard Haase
- Institute of Medical Microbiology, RWTH Aachen University Hospital, Aachen, Germany
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Cattoir V. Actinobaculum schaalii: review of an emerging uropathogen. J Infect 2011; 64:260-7. [PMID: 22209960 DOI: 10.1016/j.jinf.2011.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 12/05/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022]
Abstract
Actinobaculum schaalii is a facultative anaerobic, Gram-positive rod-shaped species phylogenetically related to Actinomyces that is likely part of the commensal flora of the human genitourinary tract. Because of its fastidious growth under aerobic conditions and its resemblance to bacteria of the resident flora, A. schaalii is frequently overlooked or considered as a contaminant. It is also difficult to identify phenotypically, still requiring molecular identification. Note that the recent technology of matrix-assisted laser desorption/ionisation time-of-flight-mass spectrometry could be a promising tool for its identification. Recent studies using sensitive PCR assays showed that its clinical significance was largely underestimated. Since its first description in 1997, A. schaalii has been responsible for numerous urinary tract infections (UTIs), mainly in elderly (usually >60 years) and patients with underlying urological conditions. Infected urines usually show many Gram-positive rods with significant leukocyturia and a negative test for nitrites. Numerous cases of severe infections have also been described, such as urosepsis, bacteremia, cellulitis, spondylodiscitis, and endocarditis. In vitro, A. schaalii is highly susceptible to β-lactams but it is resistant to ciprofloxacin and cotrimoxazole, first-choice antimicrobials for the oral treatment of UTIs. A penicillin (e.g. amoxicillin) or a cephalosporin (e.g. cefuroxime, ceftriaxone) should be the preferred treatment.
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Affiliation(s)
- Vincent Cattoir
- Centre National de Référence de la Résistance aux Antibiotiques, Laboratoire associé Entérocoques, Service de Microbiologie, CHU Côte de Nacre, Av. Côte de Nacre, 14033 Caen Cedex 9, France.
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Abstract
Actinobaculum species are anaerobic Gram-positive rods that have previously been associated with urinary tract infection (UTI) in the elderly. We report 12 patients with Actinobaculum bacteremia. Only 40% of blood cultures were clinically considered significant by the treating physicians, but most patients were treated for UTI, suggesting a possible urinary source of bacteremia. Clinicians should be aware of the pathogenic potential of Actinobaculum spp.
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Bank S, Hansen TM, Søby KM, Lund L, Prag J. Actinobaculum schaalii in urological patients, screened with real-time polymerase chain reaction. ACTA ACUST UNITED AC 2011; 45:406-10. [PMID: 21767246 DOI: 10.3109/00365599.2011.599333] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Actinobaculum schaalii can cause urinary tract infections (UTIs) and occasionally septic complications. It is a carbon dioxide-requiring Gram-positive rod which is overlooked if urine is cultured in ambient air or if there is growth of conventional species. This study aimed to find the frequency of A. schaalii in consecutive cohorts of patients with kidney stones, children with suspected UTI and patients with indwelling catheters. MATERIAL AND METHODS A quantitative real-time polymerase chain reaction (PCR) assay was used to screen consecutive urine samples from of 76 patients with kidney stones, 29 children and 37 with different indwelling catheters. RESULTS In patients with kidney stones, A. schaalii was found in seven (29%) of the 24 leucocyte esterase stix-positive urines, which was twice as often as in the stix-negative urines (p = 0.22), and in five (36%) of 14 children less than 3 years old but not in 15 children 3?15 years old (p = 0.02). The eight catheterized patients with A. schaalii (22%) were elderly and half had comorbidities. In the patients where A. schaalii was found, other uropathogens were found from five of the 15 patients with kidney stones, one of the five children and seven of the eight with an indwelling catheter. CONCLUSION Actinobaculum schaalii is common among elderly people with suspected UTI and may be clinically significant, when found alone or together with other bacteria, among children and patients treated for kidney stones.
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Affiliation(s)
- Steffen Bank
- Departments of Clinical Microbiology, Viborg Hospital, Denmark.
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31
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Abstract
Actinobaculum schaalii, which belongs to the group of Gram-positive rods, is difficult to culture. Using molecular genetics, Actinobaculum schaalii could be identified as a causing microorganism in a case of Fournier's gangrene.
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Biosensor diagnosis of urinary tract infections: a path to better treatment? Trends Pharmacol Sci 2011; 32:330-6. [PMID: 21458868 DOI: 10.1016/j.tips.2011.03.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/28/2011] [Accepted: 03/01/2011] [Indexed: 02/08/2023]
Abstract
Urinary tract infection (UTI) is among the most common bacterial infections and poses a significant healthcare burden. The standard culture-based diagnosis of UTI has a typical delay of two to three days. In the absence of definitive microbiological diagnosis at the point of care, physicians frequently initiate empirical broad-spectrum antibiotic treatment, and this has contributed to the emergence of resistant pathogens. Biosensors are emerging as a powerful diagnostic platform for infectious diseases. Paralleling how blood glucose sensors revolutionized the management of diabetes, and how pregnancy tests are now conducted in the home, biosensors are poised to improve UTI diagnosis significantly. Biosensors are amenable to integration with microfluidic technology for point-of-care (POC) applications. This review focuses on promising biosensor technology for UTI diagnosis, including pathogen identification and antimicrobial susceptibility testing, and hurdles to be surpassed in the translation of biosensor technology from bench to bedside.
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Beguelin C, Genne D, Varca A, Tritten ML, Siegrist HH, Jaton K, Lienhard R. Actinobaculum schaalii: clinical observation of 20 cases. Clin Microbiol Infect 2010; 17:1027-31. [PMID: 20854424 DOI: 10.1111/j.1469-0691.2010.03370.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Actinobaculum schaalii is a new species that has so far been isolated from human blood, urine and pus. Its importance has probably been underestimated and other Actinobaculum spp. may also have been underdiagnosed. This retrospective study comprises all known cases of A. schaalii infections identified since 2004 in the canton of Neuchâtel (170,000 inhabitants), Switzerland. Strains were cultivated and isolated in the bacteriology laboratory using its routine procedure. Identification included a Rapid ID 32 A strip (bioMérieux) and 16S rRNA gene sequencing. Twenty-one positive samples were found in 19 patients (11 male, 8 female) of all ages (range 16-91 years): 10 from urine (50%), six from blood (30%), one from both blood and urine (5%), and three from pus (15%). Thirteen out of 17 (76%) cases with either blood or urine specimens had underlying genitourinary tract pathologies. When urine cultures were positive for A. schaalii, leucocytes were found in all samples (10/10, 100%) but all nitrite tests were negative (10/10, 100%). The onset of appropriate treatment was delayed due to the diminished sensitivity of A. schaalii to the antibiotics commonly used for UTIs (i.e. ciprofloxacin and trimethoprim/sulfamethoxazole) and to the delay in microbiological diagnosis. A. schaalii should specifically be searched in all cases of leukocyturia with a negative nitrite test but with Gram-positive rods in the Gram stain, in patients with underlying genitourinary tract pathology, instead of dismissing these findings as clinically irrelevant colonization by coryneform bacteria. This infection may be much more common than previously thought.
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Affiliation(s)
- C Beguelin
- Department of Internal Medicine, HNE Community Hospital, Lausanne, Switzerland
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Cattoir V, Varca A, Greub G, Prod'hom G, Legrand P, Lienhard R. In vitro susceptibility of Actinobaculum schaalii to 12 antimicrobial agents and molecular analysis of fluoroquinolone resistance. J Antimicrob Chemother 2010; 65:2514-7. [PMID: 20952417 DOI: 10.1093/jac/dkq383] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the in vitro susceptibility of Actinobaculum schaalii to 12 antimicrobial agents as well as to dissect the genetic basis of fluoroquinolone resistance. METHODS Forty-eight human clinical isolates of A. schaalii collected in Switzerland and France were studied. Each isolate was identified by 16S rRNA sequencing. MICs of amoxicillin, ceftriaxone, gentamicin, vancomycin, clindamycin, linezolid, ciprofloxacin, levofloxacin, moxifloxacin, co-trimoxazole, nitrofurantoin and metronidazole were determined using the Etest method. Interpretation of results was made according to EUCAST clinical breakpoints. The quinolone-resistance-determining regions (QRDRs) of gyrA and parC genes were also identified and sequence analysis was performed for all 48 strains. RESULTS All isolates were susceptible to amoxicillin, ceftriaxone, gentamicin, clindamycin (except three), vancomycin, linezolid and nitrofurantoin, whereas 100% and 85% were resistant to ciprofloxacin/metronidazole and co-trimoxazole, respectively. Greater than or equal to 90% of isolates were susceptible to the other tested fluoroquinolones, and only one strain was highly resistant to levofloxacin (MIC ≥32 mg/L) and moxifloxacin (MIC 8 mg/L). All isolates that were susceptible or low-level resistant to levofloxacin/moxifloxacin (n = 47) showed identical GyrA and ParC amino acid QRDR sequences. In contrast, the isolate exhibiting high-level resistance to levofloxacin and moxifloxacin possessed a unique mutation in GyrA, Ala83Val (Escherichia coli numbering), whereas no mutation was present in ParC. CONCLUSIONS When an infection caused by A. schaalii is suspected, there is a risk of clinical failure by treating with ciprofloxacin or co-trimoxazole, and β-lactams should be preferred. In addition, acquired resistance to fluoroquinolones more active against Gram-positive bacteria is possible.
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First report of Actinobaculum schaalii urinary tract infection in North America. Diagn Microbiol Infect Dis 2010; 67:282-5. [DOI: 10.1016/j.diagmicrobio.2010.02.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 02/23/2010] [Accepted: 02/26/2010] [Indexed: 11/20/2022]
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Bank S, Jensen A, Hansen TM, Søby KM, Prag J. Actinobaculum schaalii, a common uropathogen in elderly patients, Denmark. Emerg Infect Dis 2010; 16:76-80. [PMID: 20031046 PMCID: PMC2874361 DOI: 10.3201/eid1601.090761] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This organism is identified more often by PCR than by cultivation. Actinobaculum schaalii can cause urinary tract infections and septicemia but is difficult to identify by cultivation. To obtain a fast diagnosis and identify A. schaalii, we developed a TaqMan real-time quantitative PCR. Routine urine samples were obtained from 177 hospitalized patients and 75 outpatients in Viborg County, Denmark, in 2008–2009. The PCR detected A. schaalii in 22% of samples from patients >60 years of age. This assay showed that A. schaalii is more common than implied by routine cultivation. In 90% of PCR-positive urine samples, other common uropathogens were identified. This finding suggests that A. schaalii is a common, undetected, bacterial pathogen. Our results suggest that A. schaalii may be a more common pathogen than previously thought, especially in patients with unexplained chronic urinary tract infections, who are often treated with trimethoprim or ciprofloxacin, to which A. schaalii is resistant.
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Affiliation(s)
- Steffen Bank
- Department of Clinical Microbiology, Viborg Hospital, Heibergs Allé 4, DK-8800 Viborg, Denmark.
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Bactériémie à Actinobaculum schaali chez un homme âgé. Med Mal Infect 2008; 38:617-9. [DOI: 10.1016/j.medmal.2008.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 06/04/2008] [Accepted: 09/15/2008] [Indexed: 11/18/2022]
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Three cases of serious infection caused by Aerococcus urinae: a patient with spontaneous bacterial peritonitis and two patients with bacteremia. Infection 2008; 36:288-90. [PMID: 18463786 DOI: 10.1007/s15010-008-7223-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
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Hall V. Actinomyces--gathering evidence of human colonization and infection. Anaerobe 2007; 14:1-7. [PMID: 18222714 DOI: 10.1016/j.anaerobe.2007.12.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 12/01/2007] [Indexed: 10/22/2022]
Abstract
The roles of the 'classical'Actinomyces spp. as colonizers of oral cavities of man and animals, in development of intra-oral infections and as agents of actinomycosis have been well documented. This mini-review focuses on perceptions of human colonization and infection that have emerged in the past decade, largely as a result of advances in classification, identification and direct detection from clinical material. Arguably, of the greatest importance is the recognition of actinomycosis as a major factor and indicator of poor prognosis in both infected osteoradionecrosis and bisphosphonate-associated osteonecrosis of the jaws. Among recently described species, Actinomyces graevenitzii has been isolated almost exclusively from oral and respiratory sites and may be a causative agent of actinomycosis. Conversely, several other Actinomyces spp. are isolated commonly from superficial soft tissue infections. Members of the genus Actinobaculum, which is closely related to Actinomyces, are strongly associated with urosepsis. Isolation and identification of Actinomyces and related genera by conventional methods remain difficult. Diagnosis is commonly belated and based solely upon histological findings. Development of direct detection methods may aid patient management and further elucidate clinical associations.
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Affiliation(s)
- Val Hall
- Anaerobe Reference Unit, NPHS Microbiology Cardiff, University Hospital of Wales, Cardiff CF14 4XW, UK.
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Haller P, Bruderer T, Schaeren S, Laifer G, Frei R, Battegay M, Flückiger U, Bassetti S. Vertebral osteomyelitis caused by Actinobaculum schaalii: a difficult-to-diagnose and potentially invasive uropathogen. Eur J Clin Microbiol Infect Dis 2007; 26:667-70. [PMID: 17618471 DOI: 10.1007/s10096-007-0345-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report the first case of vertebral osteomyelitis caused by Actinobaculum schaalii and review all cases of A. schaalii identified at our institution between 2002 and 2005. A. schaalii causes urinary tract infections - especially in elderly people - occasionally with septic complications.
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Affiliation(s)
- P Haller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
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Boudewijns M, Bakkers JM, Sturm PDJ, Melchers WJG. 16S rRNA gene sequencing and the routine clinical microbiology laboratory: a perfect marriage? J Clin Microbiol 2006; 44:3469-70. [PMID: 16954306 PMCID: PMC1594676 DOI: 10.1128/jcm.01017-06] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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