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Kakodkar P, Scott J, Tariq J, Du L, Wu F, Mehta N, Hamula C. Emerging pathogens Aerococcus urinae and Aerococcus sanguinicola from a Canadian tertiary care hospital. Future Microbiol 2024; 19:1321-1332. [PMID: 39109506 DOI: 10.1080/17460913.2024.2383503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/19/2024] [Indexed: 10/12/2024] Open
Abstract
Background: Aerococcus urinae and Aerococcus sanguinicola are emerging pathogens linked with urinary tract infections. We present a case series of A. urinae and A. sanguinicola isolates characterizing the spectrum of clinical presentation, microbiological characteristics and antimicrobial sensitivities.Methods: Retrospective chart review was performed on patients who grew positive cultures for A. urinae and A. sanguinicola identified on MALDI-TOF in Saskatchewan from January to June 2023. Demographic and clinical variables, antimicrobial susceptibility and prescription were documented.Results: This cohort (n = 115) had a median age 82 years. A. urinae and A. sanguinicola infections spanned from urinary tract infection (n = 96) to urosepsis (n = 6). These infections were predominantly monomicrobial (73.9%) and were susceptible to ceftriaxone, penicillin G and vancomycin. Antimicrobials were seldom prescribed within the urinary tract infection cohort (31.2%).Conclusion: Untreated A. urinae and A. sanguinicola infections can precipitate into urosepsis. The reported antimicrobial susceptibility for these Aerococcus isolates should be utilized to provide appropriate antimicrobial coverage.
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Affiliation(s)
- Pramath Kakodkar
- Department of Diagnostic & Clinical Pathology, University of Saskatchewan, Saskatoon, S7N 0W8, Canada
| | - Joel Scott
- Department of Diagnostic & Clinical Pathology, University of Saskatchewan, Saskatoon, S7N 0W8, Canada
| | - Javera Tariq
- Department of Diagnostic & Clinical Pathology, University of Saskatchewan, Saskatoon, S7N 0W8, Canada
| | - Liqin Du
- Department of Clinical Microbiology, Saskatchewan Health Authority, Saskatoon, S7N 0W8, Canada
| | - Fang Wu
- Department of Diagnostic & Clinical Pathology, University of Saskatchewan, Saskatoon, S7N 0W8, Canada
- Department of Clinical Microbiology, Saskatchewan Health Authority, Saskatoon, S7N 0W8, Canada
| | - Ninad Mehta
- Department of Diagnostic & Clinical Pathology, University of Saskatchewan, Saskatoon, S7N 0W8, Canada
- Department of Clinical Microbiology, Saskatchewan Health Authority, Saskatoon, S7N 0W8, Canada
| | - Camille Hamula
- Department of Diagnostic & Clinical Pathology, University of Saskatchewan, Saskatoon, S7N 0W8, Canada
- Department of Clinical Microbiology, Saskatchewan Health Authority, Saskatoon, S7N 0W8, Canada
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Ahmed Y, Bardia N, Judge C, Ahmad S, Malozzi C, Calderon E. Aerococcus urinae: A Rare Cause of Endocarditis Presenting With Acute Stroke. J Med Cases 2021; 12:65-70. [PMID: 34434432 PMCID: PMC8383606 DOI: 10.14740/jmc3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/25/2020] [Indexed: 11/11/2022] Open
Abstract
Aerococcus urinae is a rare organism infrequently isolated from cultures. Mostly known to cause urinary tract infection, it can cause bacteremia leading to severe urosepsis and infective endocarditis. Embolization is frequently reported with Aerococcus urinae endocarditis (AUE); hence, the presentation is highly variable. Sequelae such as various central nervous system manifestations, sepsis, valvular regurgitation with heart failure and even coronary artery involvement have been reported. We report a case of a 58-year-old man with AUE of the aortic valve, severe aortic regurgitation and embolic stroke as a result of embolization from AUE and ultimately required aortic valve replacement. Our case highlights this rare cause of endocarditis and offers insight into the variability of patient presentation and risk factors to consider.
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Affiliation(s)
- Yasir Ahmed
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Nikky Bardia
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Caleb Judge
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Sajjad Ahmad
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | | | - Eduardo Calderon
- Department of Infectious Diseases, University of South Alabama, Mobile, AL, USA
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Yaban B, Kikhney J, Musci M, Petrich A, Schmidt J, Hajduczenia M, Schoenrath F, Falk V, Moter A. Aerococcus urinae - A potent biofilm builder in endocarditis. PLoS One 2020; 15:e0231827. [PMID: 32325482 PMCID: PMC7180067 DOI: 10.1371/journal.pone.0231827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/01/2020] [Indexed: 01/15/2023] Open
Abstract
The diagnosis of infective endocarditis (IE) remains a challenge. One of the rare bacterial species recently associated with biofilms and negative cultures in infective endocarditis is Aerococcus urinae. Whether the low number of reported cases might be due to lack of awareness and misidentification, mainly as streptococci, is currently being discussed. To verify the relevance and biofilm potential of Aerococcus in endocarditis, we used fluorescence in situ hybridization to visualize the microorganisms within the heart valve tissue. We designed and optimized a specific FISH probe (AURI) for in situ visualization and identification of A. urinae in sections of heart valves from two IE patients whose 16S rRNA gene sequencing had deteced A. urinae. Both patients had a history of urinary tract infections. FISH visualized impressive in vivo grown biofilms in IE, thus confirming the potential of A. urinae as a biofilm pathogen. In both cases, FISH/PCR was the only method to unequivocally identify A. urinae as the only causative pathogen for IE. The specific FISH assay for A. urinae is now available for further application in research and diagnostics. A. urinae should be considered in endocarditis patients with a history of urinary tract infections. These findings support the biofilm potential of A. urinae as a virulence factor and are meant to raise the awareness of this pathogen.
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Affiliation(s)
- Berrin Yaban
- Biofilmzentrum, Dept. of Microbiology, Infectious Disease and Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith Kikhney
- Biofilmzentrum, Dept. of Microbiology, Infectious Disease and Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- MoKi Analytics GmbH, Marienplatz, Berlin, Germany
| | - Michele Musci
- Dept. of Congenital Heart Surgery—Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Annett Petrich
- Biofilmzentrum, Dept. of Microbiology, Infectious Disease and Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Julia Schmidt
- Biofilmzentrum, Dept. of Microbiology, Infectious Disease and Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- MoKi Analytics GmbH, Marienplatz, Berlin, Germany
| | - Maria Hajduczenia
- Biofilmzentrum, Dept. of Microbiology, Infectious Disease and Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Schoenrath
- Dept. of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Dept. of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Dept. of Cardiothoracic Surgery, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Annette Moter
- Biofilmzentrum, Dept. of Microbiology, Infectious Disease and Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- MoKi Analytics GmbH, Marienplatz, Berlin, Germany
- * E-mail:
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Mitral Valve Endocarditis with Perforation from a Urinary Source: An Unusual Case and Literature Review. Case Rep Cardiol 2019; 2019:5496851. [PMID: 31281678 PMCID: PMC6590612 DOI: 10.1155/2019/5496851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Aerococcus urinae (AU) is a rare pathogen, identified as gram-positive, catalase-negative coccus that grows in pairs and clusters which has been reported to mainly cause urinary tract infections (UTI), especially in elderly males. Treatment for this microorganism is usually with beta-lactams although cultures with antibiotic susceptibility testing are imperative. We present a case of AU endocarditis initially treated with IV antibiotics; nevertheless, the patient required emergent mitral valve replacement due to severe mitral insufficiency and perforation. We also present an analysis with high-yield points summarizing epidemiology, risk factors, microbiology, clinical features, diagnostic workup, and management of AU in general and AU endocarditis. Finally, we post a literature review of relevant cases and the impact of different variables associated with it.
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Yabes JM, Perdikis S, Graham DB, Markelz A. A rare case of Aerococcus urinae infective endocarditis in an atypically young male: case report and review of the literature. BMC Infect Dis 2018; 18:522. [PMID: 30333008 PMCID: PMC6191913 DOI: 10.1186/s12879-018-3414-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aerococcus urinae is a gram-positive, alpha-hemolytic coccus bacterium primarily implicated in less than 1 % of all symptomatic urinary tract infections. Risk factors for disease include male gender, advanced age, and comorbid genitourinary tract pathology. Infections beyond the genitourinary tract are rare, though spondylodiscitis, perineal abscesses, lymphadenitis, bacteremia, meningitis, and endocarditis have been reported. Less than fifty cases of A. urinae infective endocarditis (IE) have been described in the literature. The rare occurrence of A. urinae in human infections and resultant lack of randomized controlled trials have resulted in a significant degree of clinical uncertainty in the management of A. urinae IE. CASE PRESENTATION We present an unusual case of a forty-three year-old male with A. urinae infective endocarditis (IE) who was successfully treated with mitral valve replacement and six weeks of penicillin/gentamicin therapy. In addition, we include a comprehensive review of all reported cases of IE due to A. urinae with specific attention to therapeutic regimens and treatment durations. CONCLUSION Recent advances in diagnostic technology have led to an increase in the frequency A. urinae is diagnosed. Reviewing cases of Aerococcus urinae infections, their clinical courses and subsequent management can assist future healthcare providers and their patients.
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Affiliation(s)
- Joseph M Yabes
- Brooke Army Medical Center, Department of Infectious Disease, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA.
| | - Serafim Perdikis
- Brooke Army Medical Center, Department of Internal Medicine, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
| | - David B Graham
- Brooke Army Medical Center, Department of Cardiothoracic Surgery, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Ana Markelz
- Brooke Army Medical Center, Department of Infectious Disease, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
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Adomavicius D, Bock M, Vahl CF, Siegel E. Aerococcus urinae Mitral Valve Endocarditis-Related Stroke: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2018; 6:2324709618758351. [PMID: 29511694 PMCID: PMC5833211 DOI: 10.1177/2324709618758351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/08/2018] [Accepted: 01/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background. Aerococcus urinae is a rare causative pathogen of infective endocarditis that results in a high risk of embolic events. The mortality rate for A urinae endocarditis is high. Old age and underlying urologic conditions are the best-known risk factors for infection. Case Description. We report the clinical course of the disease in a 49-year-old man who presented symptoms of a urinary tract infection. A few days later, transthoracic echocardiography showed a conspicuous mitral valve with myxomatous alterations. Following the detection of a cerebral embolism with associated stroke symptoms, as well as at the beginning of cardiac failure, the emergency indication for the surgical treatment of mitral valve endocarditis was given. On the second day following the operation, circulatory collapse rapidly developed. Following an unsuccessful attempt at cardiopulmonary resuscitation, the patient died. Review of the Literature. From 1991 to 2017, 29 cases of A urinae–induced endocarditis have been described in PubMed and Medline. One or 2 new cases are published annually. We review all reported cases of A urinae endocarditis, with an emphasis on the predisposing factors, course, and outcomes of the disease. Conclusion. A urinae endocarditis is a rare disease primarily affecting elderly men with urinary tract pathologies and comorbidities. The course of the disease is severe, and the outcome is often fatal. A 16S rDNA polymerase chain reaction investigation of bacterial genome provides proof of the presence of A urinae. Because of the high risk of embolism, rapid treatment should focus on the diseased heart valve. Based on existing data and the experience gained from handling cases, treatment with β-lactam and aminoglycosides is recommended. It is also recommended that operative therapy take place as soon as possible.
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Affiliation(s)
- Darius Adomavicius
- University Medical Centre Mainz, Mainz, Germany
- Darius Adomavicius, Department of Cardiac Surgery, University Medical Centre Mainz, Langenbeckstr 1, Mainz 55131, Germany.
| | - Mark Bock
- Helios Dr Horst Schmidt Clinics Wiesbaden, Wiesbaden, Germany
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Tathireddy H, Settypalli S, Farrell JJ. A rare case of aerococcus urinae infective endocarditis. J Community Hosp Intern Med Perspect 2017. [PMID: 28638578 PMCID: PMC5473194 DOI: 10.1080/20009666.2017.1314072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction:Aerococcus urinae is a rare cause of infective endocarditis. Aerococcus is a gram positive cocci that is easily misidentified as Staphylococci or Streptococci. The true incidence rate of this pathogen is likely underestimated. Recent advances in laboratory diagnostic methods with matrix-associated laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) have lead to increased recognition of this pathogen in the clinical microbiology lab, and awareness as a cause of infective endocarditis in the infectious disease community. Case reports: Aerococcus usually affects males with underlying urinary tract conditions. Herein, we report a case of prosthetic aortic valve endocarditis caused by Aerococcus urinae. Discussion: Our patient was considered high risk for cardiac surgery and was treated successfully with intravenous antibiotics alone for six weeks. Conclusion: Infective endocarditis should be considered in all cases of Aerococcus bacteremia and appropriate diagnostic evaluations pursued. Abbreviations: AV: Aortic valve; IE: Infective endocarditis
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Affiliation(s)
- Harsha Tathireddy
- Department of Internal Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Sahitya Settypalli
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - John J Farrell
- Department of Internal Medicine, Division of Infectious Disease, OSF Saint Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Ha L, Niknam N, Mankame S, Koshy R. A rare case of perineal abscess caused by aerococcus urinae. IDCases 2017; 7:44-46. [PMID: 28105405 PMCID: PMC5226662 DOI: 10.1016/j.idcr.2016.11.001] [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: 10/20/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Abstract
Aerococcus urinae, a previously misidentified pathogen, has become increasingly recognized to cause severe and even fatal infections. Aerococcus-related perineal abscess infections have not previously been reported in the literature. Most reported cases of infections caused by Aerococcus are urinary tract infections, bacteremia, and even rare cases of endocarditis. We report an unusual case of a perineal abscess caused by Aerococcus urinae.
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