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Kling K, Menon A, Norconk P, Zhu D, Zembower T, Qi C. Evaluation of gradient diffusion in vitro susceptibility testing of Aerococcus urinae. J Glob Antimicrob Resist 2024; 38:389-400. [PMID: 39117144 DOI: 10.1016/j.jgar.2024.07.014] [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: 10/25/2023] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE Aerococcus urinae antimicrobial susceptibility testing can be performed via broth microdilution with Mueller-Hinton broth supplemented with lysed horse blood. We sought to compare this with the commonly used gradient diffusion method. METHODS We compared broth microdilution with Mueller-Hinton broth supplemented with lysed horse blood and gradient diffusion via Mueller-Hinton agar supplemented with sheep blood for 190 A. urinae isolates against 16 antimicrobials. RESULTS No antimicrobials demonstrated more than 90% essential and categorical agreement, and fewer than 3% demonstrated major and very major error rates. Trimethoprim-sulfamethoxazole demonstrated an 81% major error rate and ceftriaxone demonstrated a 76% very major error rate. Agar dilution with lysed horse blood was performed for trimethoprim-sulfamethoxazole against 94 isolates and showed 100% susceptibility, consistent with previous studies. CONCLUSIONS Given its limitations in detecting resistant strains, our findings cannot support the routine use of gradient diffusion with Mueller-Hinton agar supplemented with sheep blood for A. urinae in lieu of the Clinical and Laboratory Standards Institute method. Our results suggest that A. urinae is usually susceptible to penicillin, linezolid, tetracycline, and vancomycin. Future studies should evaluate alternative testing methods for clinical microbiology laboratories.
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Affiliation(s)
- Kendall Kling
- Department of Pathology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Ward 3140, Chicago IL, 60611, USA; Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 676 N. St Clair Street, Suite 940, Chicago, IL, 60611, USA.
| | - Adil Menon
- Department of Pathology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Ward 3140, Chicago IL, 60611, USA
| | - Paige Norconk
- Department of Pathology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Ward 3140, Chicago IL, 60611, USA
| | - David Zhu
- Department of Pathology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Ward 3140, Chicago IL, 60611, USA
| | - Teresa Zembower
- Department of Pathology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Ward 3140, Chicago IL, 60611, USA; Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 676 N. St Clair Street, Suite 940, Chicago, IL, 60611, USA
| | - Chao Qi
- Department of Pathology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Ward 3140, Chicago IL, 60611, USA
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Angulo-López I, Fernández-Vecilla D, Aragón-Díez J, Lasa-Epelde L, Díaz-de-Tuesta JL. In vitro susceptibility of fosfomycin in Aerococcus spp. isolated from urine samples. Clin Microbiol Infect 2023:S1198-743X(23)00207-0. [PMID: 37179008 DOI: 10.1016/j.cmi.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/15/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Itziar Angulo-López
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain; Biocruces Bizkaia Health Research Institute, Barakaldo (Vizcaya), Spain.
| | - Domingo Fernández-Vecilla
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain; Biocruces Bizkaia Health Research Institute, Barakaldo (Vizcaya), Spain
| | - Julia Aragón-Díez
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain; Biocruces Bizkaia Health Research Institute, Barakaldo (Vizcaya), Spain
| | - Lourdes Lasa-Epelde
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain
| | - José Luis Díaz-de-Tuesta
- Clinical Microbiology Service, Basurto University Hospital, OSI Bilbao-Basurto, Bilbao (Vizcaya), Spain; Biocruces Bizkaia Health Research Institute, Barakaldo (Vizcaya), Spain
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Tiong CW, Bartolo C, Walton A, Athan E. Aerococcus urinae, a rare cause of aortic root abscess: a case report. J Med Case Rep 2022; 16:438. [PMID: 36397095 PMCID: PMC9670598 DOI: 10.1186/s13256-022-03564-8] [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: 01/24/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aerococcus urinae is a bacterium of emerging clinical interest that most commonly causes urinary tract infections (UTI) but can also result in invasive infections. It is a catalase-negative, alpha-haemolytic gram-positive coccus that grows in clusters or tetrads and usually causes urinary tract infections. While rare, infective endocarditis must be considered when A. urinae is isolated in blood culture. The mortality rate of A. urinae infective endocarditis is similar to overall endocarditis mortality. We report a rare case of aortic root abscess caused by A. urinae. CASE PRESENTATION An 82-year-old Caucasian man presented to hospital with behavioural change and severe malnutrition and was managed for psychotic depression. On day 34 of his inpatient stay, a febrile episode prompted blood cultures, which grew Aerococcus. urinae. Investigations revealed a bicuspid aortic valve, aortic valve endocarditis and aortic root abscess. He also had prostatomegaly. He underwent aortic valve replacement, received 6 weeks of intravenous ceftriaxone and recovered. CONCLUSION Infective endocarditis should be considered in patients with persistent Aerococcus urinae bacteraemia. Accurate identification with mass spectrometry is recommended to avoid misidentification as staphylococcus, streptococcus or enterococcus, which is a possibility with conventional laboratory methods.
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Affiliation(s)
- Chong Wei Tiong
- Department of General Medicine, Barwon Health, Geelong, VIC, Australia.
| | - Caroline Bartolo
- Department of Infectious Diseases, Barwon Health, Geelong, VIC, Australia
| | - Aaron Walton
- Department of General Medicine, Barwon Health, Geelong, VIC, Australia
- Department of Infectious Diseases, Barwon Health, Geelong, VIC, Australia
| | - Eugene Athan
- Department of Infectious Diseases, Barwon Health, Geelong, VIC, Australia
- Deakin University, Melbourne, VIC, Australia
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Scholtz SL, Faron ML, Buchan BW, Ledeboer NA. Comparison of Methods for Determining the Antibiotic Susceptibility of Aerococcus Species in a Clinical Setting. Am J Clin Pathol 2022; 157:781-788. [PMID: 34893797 DOI: 10.1093/ajcp/aqab195] [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: 06/18/2021] [Accepted: 10/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Aerococcus spp are Gram-positive cocci increasingly recognized as uropathogens. The Clinical and Laboratory Standards Institute recently published specific breakpoints for Aerococcus spp (M45, third edition); however, the standardized method used for antimicrobial susceptibility testing (AST) requires media not often maintained in clinical laboratories. The purpose of this study was to evaluate and compare alternative methods of AST for Aerococcus isolates. METHODS AST was performed on 134 clinical isolates using the Etest on three different types of agar, Vitek 2, and BD Phoenix. These results were compared with broth microdilution using the Sensititre STP6F. RESULTS Aerococcus exhibited low minimum inhibitory concentrations to benzylpenicillin, meropenem, linezolid, and vancomycin. Variable resistance was seen to levofloxacin, ceftriaxone, and tetracycline. Meropenem and vancomycin met all acceptance criteria with every alternative method tested. Benzylpenicillin and linezolid did not meet essential agreement on any AST method. Tetracycline met the majority of acceptance criteria with the exception of more than 3% very major error when using the Etest on chocolate agar, the Vitek 2, and BD Phoenix. CONCLUSIONS Overall, the alternate AST method with the highest agreement with broth microdilution was the Etest on Mueller-Hinton agar with 5% sheep blood and may be an optimal alternative to broth microdilution.
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Affiliation(s)
| | | | - Blake W Buchan
- Medical College of Wisconsin, Milwaukee, WI, USA
- Wisconsin Diagnostic Laboratories, Milwaukee, WI, USA
| | - Nathan A Ledeboer
- Medical College of Wisconsin, Milwaukee, WI, USA
- Wisconsin Diagnostic Laboratories, Milwaukee, WI, USA
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Clinical and microbiological characterization of Aerococcus urinae bacteraemias at Helsinki metropolitan area, Finland. Eur J Clin Microbiol Infect Dis 2022; 41:751-760. [PMID: 35257275 PMCID: PMC9033721 DOI: 10.1007/s10096-022-04415-6] [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: 09/05/2021] [Accepted: 01/31/2022] [Indexed: 12/03/2022]
Abstract
Our objective was to assess the incidence of bacteraemic Aerococcus urinae cases at Helsinki metropolitan area, Finland, from a 6-year study period (2013 to 2018) and to further characterize available cases. The study evaluates the outcome of commonly used cefuroxime treatment and determinate a set of A. urinae in vitro antimicrobial susceptibilities for benzylpenicillin, cefuroxime, and ceftriaxone. Clinical records of A. urinae bacteraemic patients were reviewed retrospectively. Antimicrobial susceptibility testing was performed by disk diffusion, gradient test, and broth microdilution for 139–141 clinical A. urinae isolates. Clinical data of 72/77 patients were combined with the in vitro susceptibilities. We found an increasing number of bacteraemic A. urinae cases within 6-year study period (p = 0.01). The patients were mainly elderly males, and all suffered from underlying conditions. A total of 27.3% of cases (21/77) showed polymicrobial blood cultures. Thirty-day mortality was 22.1%. Cefuroxime was the initial empiric antimicrobial agent given for 66/76 of the patients and treatment outcome was favorable for 20/22 patients who received cefuroxime at least up to day 5. All isolates were susceptible to benzylpenicillin and cefuroxime interpreted by EUCAST breakpoints for Aerococci and PK-PD breakpoints, respectively. MIC determinations gave variable results for ceftriaxone, 2.1–2.9% of the isolates were resistant. To conclude, it seems that the number of bacteraemic Aerococcus urinae cases is increasing at Helsinki metropolitan area, Finland, reflecting the growing blood culture sampling. Clinical A. urinae isolates were susceptible to cefuroxime in vitro. Treatment data indicate that empirical cefuroxime started for possibly urinary tract -derived community-acquired bacteraemia covers A. urinae.
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Rosales-Castillo A, Jiménez-Guerra G, Ruiz-Gómez L, Expósito-Ruíz M, Navarro-Marí JM, Gutiérrez-Fernández J. Emerging Presence of Culturable Microorganisms in Clinical Samples of the Genitourinary System: Systematic Review and Experience in Specialized Care of a Regional Hospital. J Clin Med 2022; 11:jcm11051348. [PMID: 35268439 PMCID: PMC8911399 DOI: 10.3390/jcm11051348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
The detection of emerging pathogens responsible for genitourinary infections has increased with technological advances. We conducted a systematic review of publications on the involvement of these microorganisms in genitourinary samples, and we also investigated their presence and antibiotic susceptibility in samples from patients at our regional hospital (Granada, Spain). The MEDLINE database was searched up to 31 December 2020, and a cross-sectional descriptive study was performed of results obtained in urine samples and genital exudates from January 2016 through December 2019. The review highlighted the frequent involvement of Neisseria meningitidis in genital infections, while the data on other microorganisms were consistent with findings in our patient series. The emerging microorganisms most often responsible for urinary tract infections were Streptococcus bovis (58.5%) and Gardnerella vaginalis (23.6%) in females, and S. bovis (32.3%), Aerococcus urinae (18.6%), and Corynebacterium spp. (16.9%) in males; those most frequently reported in genital infections were S. viridans (36.4%) in females and C. glucuronolyticum (32.2%) and G. vaginalis (35.6%) in males. In general, emerging pathogens are resistant to conventional antibiotics such as penicillin. However, there has also been an increase in beta-lactam resistance by the S. bovis group and Corynebacterium spp. The systematic review showed that emerging microorganisms are responsible for only a small percentage of genitourinary infections but are of major clinical interest, with a predominance of the S. bovis group, G. vaginalis, Lactobacillus spp., Aerococcus spp., and Corynebacterium spp. in urine samples and of G. vaginalis and C. glucuronolyticum in genital samples. Given the increasing resistance to antibiotics empirically prescribed in patients with genitourinary infections, it is recommended to create an antibiogram in all cases.
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Affiliation(s)
- Antonio Rosales-Castillo
- Servicio de Medicina Interna, Virgen de las Nieves University Hospital & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain;
- Program in Clinical Medicine and Public Health, University of Granada & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18016 Granada, Spain
| | - Gemma Jiménez-Guerra
- Laboratory of Microbiology, Virgen de las Nieves University Hospital & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain; (G.J.-G.); (J.M.N.-M.)
| | - Lara Ruiz-Gómez
- Department of Microbiology, School of Medicine, University of Granada & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de la Investigación 11, 18016 Granada, Spain;
| | - Manuela Expósito-Ruíz
- Unit of Biostatistics, Department of Statistics, School of Medicine, University of Granada, 18016 Granada, Spain;
| | - José María Navarro-Marí
- Laboratory of Microbiology, Virgen de las Nieves University Hospital & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain; (G.J.-G.); (J.M.N.-M.)
| | - José Gutiérrez-Fernández
- Program in Clinical Medicine and Public Health, University of Granada & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18016 Granada, Spain
- Laboratory of Microbiology, Virgen de las Nieves University Hospital & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain; (G.J.-G.); (J.M.N.-M.)
- Department of Microbiology, School of Medicine, University of Granada & Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Avenida de la Investigación 11, 18016 Granada, Spain;
- Correspondence:
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Tai DBG, Go JR, Fida M, Saleh OA. Management and treatment of Aerococcus bacteremia and endocarditis. Int J Infect Dis 2020; 102:584-589. [PMID: 33157289 DOI: 10.1016/j.ijid.2020.10.096] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES We describe our multicenter experience on diagnosis and management of Aerococcus bacteremia including the susceptibility profile of Aerococcus species and a suggested algorithm for clinicians. METHODS Retrospective study of all patients with positive blood cultures for Aerococcus species from January 2005 to July 2020 in our institution with clinical data and susceptibility profile. Data were collected from both electronic health record and clinical microbiology laboratory database. RESULTS There were 219 unique isolates with only the susceptibility profiles available, while 81 patients had clinical information available. Forty-nine of those cases were deemed as true bloodstream infection and the rest were of unclear clinical significance. Cases of endocarditis (n = 7) were high-grade, monomicrobial bacteremia caused by Aerococcus urinae. Patients with endocarditis were younger (66 vs 80 p < 0.05). The risk for endocarditis was higher if duration of symptoms was longer than 7 days (OR 105, 95% CI: 5-2271), or if there were septic emboli (OR 71, 95% CI: 3-1612). A DENOVA score cutoff of ≥ 3 was 100% sensitive and 89% specific in detecting endocarditis. The 30-day and 3-month all-cause mortality for bacteremia was 17% and 24%, respectively. Six out of seven patients with endocarditis survived. CONCLUSIONS Antibiotic regimen for aerococcal bloodstream infections and endocarditis should be guided by species identification and antimicrobial susceptibility testing. DENOVA scoring system's performance in this study is more congruent to other studies. Hence, it can be used as an adjunctive tool in assessing the need for echocardiogram to rule out endocarditis. In our experience, two and four weeks of treatment for bloodstream infections and endocarditis, respectively, had good outcomes.
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Affiliation(s)
| | - John Raymond Go
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, USA
| | - Madiha Fida
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, USA
| | - Omar Abu Saleh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, USA
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Sous N, Piwoz JA, Baer AZ, Bhavsar SM. Subacute Aerococcus urinae Infective Endocarditis With Mycotic Aneurysms in a Pediatric Patient: Case Report and Literature Review. J Pediatric Infect Dis Soc 2019; 8:492-494. [PMID: 30892601 DOI: 10.1093/jpids/piz016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/09/2019] [Indexed: 12/11/2022]
Abstract
Aerococcus urinae has been found to cause urinary tract infection in elderly patients and has been reported as a rare cause of infective endocarditis associated with significant morbidity and death in adults. However, information regarding its occurrence in children is lacking. We report here the case of a pediatric patient with subacute A urinae infective endocarditis with mycotic aneurysms.
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Affiliation(s)
- Natalie Sous
- Rutgers New Jersey Medical School, Medicine and Pediatrics, Newark, New Jersey
| | - Julia A Piwoz
- Joseph M. Sanzari Children's Hospital at Hackensack Meridian Health, Hackensack, New Jersey
| | - Aryeh Z Baer
- Joseph M. Sanzari Children's Hospital at Hackensack Meridian Health, Hackensack, New Jersey
| | - Sejal Makvana Bhavsar
- Joseph M. Sanzari Children's Hospital at Hackensack Meridian Health, Hackensack, New Jersey
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