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Journal of Surgical Case Reports Oct 2019and are two facultative anaerobes that are common contaminants of human flora; namely the urinary tract, the female genital tract and the gastrointestinal tract. has...
and are two facultative anaerobes that are common contaminants of human flora; namely the urinary tract, the female genital tract and the gastrointestinal tract. has been linked with abscesses, decubitus ulcers and purulent urethritis, while has been associated with urinary tract infections, bacteremia and Fournier's gangrene. Here we present a case report of an 84-year-old female patient found to have a necrotizing soft tissue infection caused by and To our knowledge, this is the first case report that documents as a causal agent of a necrotizing infection.
PubMed: 31636892
DOI: 10.1093/jscr/rjz286 -
Heliyon Apr 2024affects elderly people and is associated with individuals with urological-related predispositions, but can be found in a variety of locations, such as cutaneous,...
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 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 infections. This pathogen is hard to isolate, and is resistant to commonly used empirical antimicrobials.
PubMed: 38590897
DOI: 10.1016/j.heliyon.2024.e28589 -
Microorganisms Mar 2021an emerging, opportunistic pathogen and its connection to non-infectious diseases and conditions, such as prostate or bladder cancer, or chronic inflammation has been...
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 Illumina sequencing, to establish 's prevalence in urinary tract-related samples, its relation to other bacteria, and its potential association with patients' conditions and samples' characteristics. -positive samples were significantly more diverse than . negative and between-group diversity was higher than intra-group. sp., sp., and sp. were significantly more often present in -positive samples; thus, we suggest these species are concomitants, while and Staphylococcaceae were more often identified in -negative samples; therefore, we propose and these species are mutually exclusive. Additionally, a significantly higher prevalence in patients with ureter stricture associated hydronephrosis ( = 0.020) was noted. We suggest that could be an early polybacterial biofilm colonizer, together with concomitant species, known for pro-inflammatory features.
PubMed: 33807120
DOI: 10.3390/microorganisms9030669 -
Microbiology Spectrum Dec 2022Actinotignum schaalii is an underrecognized Gram-positive bacillus that is associated with urinary tract infections and cutaneous abscesses. The role of A. schaalii in...
Actinotignum schaalii is an underrecognized Gram-positive bacillus that is associated with urinary tract infections and cutaneous abscesses. The role of A. schaalii in invasive infections continues to be unappreciated because the bacteria can be isolated from a diverse spectrum of clinical specimens, ranging from being a single pathogen in urine and blood cultures to being deemed a colonizer in polymicrobial anaerobic cultures of sterile fluids and tissues. We conducted a microbiological analysis of clinical isolates obtained from 2012 through 2019. A total of 86 isolates were analyzed; 37 (43%) were from blood cultures, 35 (41%) were from deep wounds and abscesses, 6 (7%) were from urine samples, and the rest were recovered from peritoneal, kidney, and scrotal fluid samples. Urinary tract infections were clinically identified as the source of most cases of bacteremia, although no simultaneous urine cultures yielded positive results. The 16S rRNA gene sequences were available for 32 isolates (37%). Phylogenetic analysis revealed that AS.1/AS.2 strains caused a larger proportion of bloodstream infections (BSIs) (100% versus 52% [ = 0.01]) and trended toward a higher rate of hospitalization (91% versus 76% [ = 0.18]) but had a lower clindamycin MIC (0.12 versus >256 μg/mL). Our study emphasizes the emergence of A. schaalii as a pathogen in human urine samples, BSIs, and skin and soft tissue infections. It highlights the pitfalls of current laboratory methods in recovering and identifying this organism from clinical specimens, particularly urine samples. Phylogenetic analysis showed unique genotypic sequences for A. schaalii AS.1/AS.2 strains causing urosepsis, which requires further study to identify potential virulence factors. Actinotignum schaalii is an underrecognized Gram-positive bacillus due to its special growth requirements and prior phenotypic identification methods, and it is often mistaken as a contaminant. It has been associated with various clinical syndromes, from urinary tract infections to cutaneous infections. The widespread use of molecular diagnostic methods allowed for improved detection. However, its role in invasive infections remains underappreciated. We conducted a detailed microbiological analysis to improve our understanding of this organism's genotypic and phenotypic characteristics. Our results highlight the pitfalls of clinical laboratory recovery, particularly from urine cultures. Although most BSIs were caused by urinary tract infections, no simultaneous urine cultures identified A. schaalii, largely due to the failure of phenotypic methods to reliably isolate and identify this organism. Additionally, this is the first study demonstrating A. schaalii strains with differences in clinical and microbiological characteristics, raising the possibility of potential bacterial virulence factors contributing to invasive infections.
Topics: Humans; Abscess; RNA, Ribosomal, 16S; Phylogeny; Canada; Urinary Tract Infections; Sepsis; Bacteria, Anaerobic
PubMed: 36409090
DOI: 10.1128/spectrum.03442-22 -
Germs Sep 2022is a small Gram-positive facultative anaerobic coccoid rod that was reclassified in 1997 from the genus and is difficult to culture with usual microbiological...
INTRODUCTION
is a small Gram-positive facultative anaerobic coccoid rod that was reclassified in 1997 from the genus and is difficult to culture with usual microbiological techniques, as it is slowly growing. is an emerging human pathogen that is most commonly implicated in urinary tract infections (UTIs), but has also been isolated less frequently from abscesses of various sites (such as the skin, the genitourinary tract, surgical sites or intraabdominal).
METHODS
All cases where was identified during a 6-year period (January 2016 - January 2022) in the University Hospital of Heraklion were reviewed.
RESULTS
was isolated in 11 cultures from 10 patients. The site of infection was skin and soft tissue in nine out of eleven cultures (81.8%) and the bone was the site of infection in two patients (18.2%). Most cultures were polymicrobial. The median age of patients was 55.5 years (interquartile range 34-63 years), and 80% (n=8) were male. was susceptible to beta-lactams, quinolones and vancomycin, but resistant to clindamycin, erythromycin and metronidazole. Moreover, two cases of diabetic patients diagnosed with polymicrobial diabetic foot osteomyelitis from this organism are presented in detail. Both patients were successfully managed with targeted antimicrobial treatment and prompt surgical management.
CONCLUSIONS
is an emerging pathogen that is likely under-reported due to difficulties in isolation and identification. Herein two cases of diabetic foot osteomyelitis are also presented in detail, successfully managed with targeted antimicrobial therapy and surgical debridement.
PubMed: 37680677
DOI: 10.18683/germs.2022.1343 -
Clinical Chemistry and Laboratory... Jun 2024The EFLM Task and Finish Group Urinalysis has updated the ECLM European Urinalysis Guidelines (2000) on urinalysis and urine bacterial culture, to improve accuracy of...
BACKGROUND
The EFLM Task and Finish Group Urinalysis has updated the ECLM European Urinalysis Guidelines (2000) on urinalysis and urine bacterial culture, to improve accuracy of these examinations in European clinical laboratories, and to support diagnostic industry to develop new technologies.
RECOMMENDATIONS
Graded recommendations were built in the following areas.
MEDICAL NEEDS AND TEST REQUISITION
Strategies of urine testing are described to patients with complicated or uncomplicated urinary tract infection (UTI), and high or low-risk to kidney disease.
SPECIMEN COLLECTION
Patient preparation, and urine collection are supported with two quality indicators: contamination rate (cultures), and density of urine (chemistry, particles).
CHEMISTRY
Measurements of both urine albumin and α1-microglobulin are recommended for sensitive detection of kidney disease in high-risk patients. Performance specifications are given for urine protein measurements and quality control of multiproperty strip tests.
PARTICLES
Procedures for microscopy are reviewed for diagnostic urine particles, including urine bacteria. Technologies in automated particle counting and visual microscopy are updated with advice how to verify new instruments with the reference microscopy.
BACTERIOLOGY
Chromogenic agar is recommended as primary medium in urine cultures. Limits of significant growth are reviewed, with an optimised workflow for routine specimens, using leukocyturia to reduce less important antimicrobial susceptibility testing. Automation in bacteriology is encouraged to shorten turn-around times. Matrix assisted laser desorption ionization time-of-flight mass spectrometry is applicable for rapid identification of uropathogens. and are taken into the list of uropathogens. A reference examination procedure was developed for urine bacterial cultures.
PubMed: 38534005
DOI: 10.1515/cclm-2024-0070 -
Microorganisms Dec 2023is an aerobic Gram-positive coccus that grows as tiny alpha-hemolytic colonies. is a slow-growing facultative anaerobic Gram-positive rod. These bacteria are part of...
is an aerobic Gram-positive coccus that grows as tiny alpha-hemolytic colonies. 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 and 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% CO atmosphere for 48 h and from 24 to 48 h for and , 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 and 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. and 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.
PubMed: 38138052
DOI: 10.3390/microorganisms11122908 -
Case Reports in Nephrology and Dialysis 2022Accurate diagnosis and treatment of febrile urinary tract infections (UTI) during childhood are important for the prevention of renal parenchymal damage and functional...
Accurate diagnosis and treatment of febrile urinary tract infections (UTI) during childhood are important for the prevention of renal parenchymal damage and functional loss, and detection of underlying diseases related to chronic kidney disease (CKD). ()-related febrile UTI in children is rare, and its incidence and risk factors remain unclear. A 3-year-old boy with a history of UTI presented with fever and vomiting. Although the culture of his urine specimen in air was negative, was observed in a 5% carbon dioxide (CO) culture condition, as well as an anaerobic one. A diagnosis of febrile UTI was made, and he recovered with antibiotic therapy. He was found to have CKD associated with vesicoureteral reflux (VUR) after further investigations. is one of the causative agents of febrile UTI in children with urinary tract abnormalities. Although the culture in the air could show negative results, urine culture in 5% CO and anaerobic conditions is useful for diagnosis. Our case is the youngest and the first known case of -related febrile UTI associated with VUR in children.
PubMed: 36518361
DOI: 10.1159/000526398 -
Microorganisms Aug 2022(1) Background: is an emerging, opportunistic pathogen often linked with UTIs but can extend beyond the urogenital system. Data on the clinical significance of are...
(1) Background: is an emerging, opportunistic pathogen often linked with UTIs but can extend beyond the urogenital system. Data on the clinical significance of are still emerging. (2) Methods: A retrospective review of isolates in a Canadian tertiary care hospital was conducted. The clinical data of patients that grew 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 were identified. was primarily involved in UTIs ( = 17), abscesses ( = 9), bacteremia ( = 6), septic arthritis ( = 5), and ulcers ( = 5). had a slight predilection for polymicrobial infections (51.1%, = 22 out of 43), with ( = 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 ( = 5) is the most frequently prescribed antibiotic. (4) Conclusions: The non-urogenic clinical significance of remains undervalued. The management of infection is multimodal, consisting predominantly of antimicrobials and surgical procedures specific to the etiology. Clinicians should request sensitivities for so that appropriate antimicrobial coverage can be provided.
PubMed: 36014029
DOI: 10.3390/microorganisms10081608 -
Internal Medicine (Tokyo, Japan) Jun 2021We herein report a case of presumed septic shock due to Actinotignum schaalii bacteremia with urinary tract infection. A 65-year-old Japanese man suffering from a fever...
We herein report a case of presumed septic shock due to Actinotignum schaalii bacteremia with urinary tract infection. A 65-year-old Japanese man suffering from a fever was diagnosed with septic shock due to urinary tract infection. A urine sample was additionally incubated under 5% CO and anaerobic conditions after A. schaalii was identified in a blood culture, but A. schaalii was not detected in the urine culture. If Gram-positive rods are observed on Gram staining of a urine sample in symptomatic patients with a predisposing urogenital condition, 5% CO and an anaerobic culture of a urine sample should be performed immediately.
Topics: Actinomycetaceae; Aged; Bacteremia; Humans; Male; Shock, Septic; Urinary Tract Infections
PubMed: 33518555
DOI: 10.2169/internalmedicine.4351-19