Preanalytical, Analytical and Postanalytical Analyses on Corynebacterium spp. and Actinomycetaceae in Urine Samples of Patients with Suspected Urinary Tract Infection-A Hypothesis-Forming Observational Study

A hypothesis-forming exploratory cross-sectional assessment was conducted to assess the occurrence and relevance of Gram-positive rod-shaped bacteria like Corynebacterium spp. and Actinomycetaceae in human urine samples. In total, 1170 urine samples from 1031 inpatients with suspected urinary tract infection were assessed for culture-based growth of Gram-positive rod-shaped bacteria applying API Coryne assays, matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF-MS), and in-house 16S rRNA gene sequencing. Overall, 502 different bacterial colonies from 346 urine samples taken from 324 inpatients were observed. The three quantitatively most abundant genera or genus clusters were Corynebacterium (254 isolates, 62%), Actinomyces/Winkia (79 isolates, 19%), and Actinotignum/Actinobaculum (29 isolates, 7%). Compared to sequencing, the diagnostic accuracy of all assessed competitor assays from the diagnostic routine was <80% for differentiation on the genus level and <30% for differentiation on the species level. Prolongated incubation for 4 days compared to 2 days resulted in additional detection of 15% of the totally recorded Gram-positive rod-shaped bacteria. An approximately 5-fold increased detection rate in mid-stream urine compared to urine acquired applying alternative sampling strategies was observed. In conclusion, in the rare event of the suspected clinical relevance of such findings, confirmatory testing with invasively sampled urine should be considered due to the high contamination rate observed in mid-stream urine. Confirmatory testing by DNA-sequencing methods should be considered if an exact identification of genus or species is regarded as relevant for the individual choice of the therapeutic strategy.

anitrata)

Background

Canine aortic valve endocarditis carries a poor prognosis. In the current literature there are only two reports of infectious endocarditis associated with Actinomyces; Actinomyces turicensis and an Actinomyces-like organism. Endocarditis due to Actinomyces neuii subsp. anitratus (now known as Winkia neuii subsp. anitrata) has rarely been reported in humans, and to the best of our knowledge, has never been reported in dogs.

Case presentation

A 4 year-3 months old female neutered Great Dane presented with lethargy, hyporexia, ‘praying position’ stance, acute onset of cherry eye and pyrexia. A subtle diastolic heart murmur was detected on thoracic auscultation and echocardiology revealed an irregular lesion adhered to the ventricular aspect of the aortic valve, suggestive of aortic valve endocarditis. Peripheral blood was collected for blood culture. Following 10 days of incubation, blood cultures yielded a growth of aerobic gram-positive filamentous rods which were further biochemically (BioMerieux API Coryne profiling strip) identified as Actinomyces neuii subsp. anitratus. The patient was treated with marbofloxacin and amoxicillin/clavulanic acid for five consecutive months. On repeat echogram, following treatment completion, there was no evidence of aortic valve endocarditis. To the best of our knowledge this is the first case report documenting successful treatment of aortic valve endocarditis caused by Actinomyces neuii subsp. anitratus in a dog.

Conclusions

Despite the poor prognosis of canine infectious aortic valve endocarditis, patients with Actinomyces neuii subsp. anitratus infection might have a favourable outcome. It is therefore important identifying the underling infectious cause, as it may have a significant impact on prognosis and treatment outcome when it is caused by Actinomyces neuii subsp. anitratus.