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Microbiology Spectrum Feb 2023Aerococcus urinae and Aerococcus sanguinicola have been increasingly recognized as causative agents of urinary tract infection (UTI) during the last decade. Nitroxoline...
Aerococcus urinae and Aerococcus sanguinicola have been increasingly recognized as causative agents of urinary tract infection (UTI) during the last decade. Nitroxoline achieves high urinary concentrations after oral administration and is recommended in uncomplicated UTI in Germany, but its activity against spp. is unknown. The aim of this study was to assess the susceptibility of clinical species isolates to standard antibiotics and to nitroxoline. Between December 2016 and June 2018, 166 and 18 isolates were recovered from urine specimens sent to the microbiology laboratory of the University Hospital of Cologne, Germany. Susceptibility to standard antimicrobials was analyzed by disk diffusion (DD) according to EUCAST methodology, nitroxoline was tested by DD and agar dilution. Susceptibility of spp. to benzylpenicillin, ampicillin, meropenem, rifampicin, nitrofurantoin, and vancomycin was 100% and resistance was documented only against ciprofloxacin (20 of 184; 10.9%). MICs of nitroxoline in isolates were low (MIC 1/2 mg/L) while significantly higher MICs were observed in (MIC 64/128 mg/L). If the EUCAST nitroxoline breakpoint for E. coli and uncomplicated UTI was applied (16 mg/L), 97.6% of isolates would be interpreted as susceptible while all isolates would be considered resistant. Nitroxoline demonstrated high activity against clinical isolates, but low activity against Nitroxoline is an approved antimicrobial for UTI and could be an alternative oral drug to treat urinary tract infection, yet clinical studies are needed to demonstrate this potential . and have been increasingly recognized as causative agents in urinary tract infections. Currently, there are few data available on the activity of different antibiotics against these species and no data on nitroxoline. We demonstrate that clinical isolates in Germany are highly susceptible to ampicillin, while resistance to ciprofloxacin was common (10.9%). Additionally, we show that nitroxoline is highly active against , but not against , which based on the presented data, should be considered intrinsically resistant. The presented data will help to improve the therapy of urinary tract infections by species.
PubMed: 36847493
DOI: 10.1128/spectrum.02763-22 -
IDCases 2023We describe the first adult case with positive urine cultures as the proven cause of recurrent socially disabling malodorous urine. Bacterial strain specific factors as...
We describe the first adult case with positive urine cultures as the proven cause of recurrent socially disabling malodorous urine. Bacterial strain specific factors as well as host factors are shown to play a role. The condition can be resolved with proper antibiotics.
PubMed: 36505906
DOI: 10.1016/j.idcr.2022.e01657 -
European Journal of Pediatrics Feb 2023Aerococcus urinae (A. urinae) is primarily recognized as a common pathogen in the geriatric population, causing urinary tract infection (UTI), sepsis, and endocarditis,...
Aerococcus urinae (A. urinae) is primarily recognized as a common pathogen in the geriatric population, causing urinary tract infection (UTI), sepsis, and endocarditis, predominantly in female patients. In the paediatric population, only a few case reports exist suggesting A. urinae causes malodorous urine in otherwise healthy boys. In this study, we investigated the spectrum of clinical and laboratory presentations of A. urinae detection in children. A retrospective, single-centre, case series including all patients with the detection of A. urinae during a 7-year study period. Patients with detection of A. urinae only in non-urogenital skin swabs were excluded. A total of 40 samples from 33 patients were identified of which 20 patients were included in the final analysis. The median (IQR) age was 6.8 (2.9-9.5) years; 18 (90%) patients were boys. Four patients were diagnosed with a UTI, six had malodorous urine without UTI, three were diagnosed with balanitis and seven showed A. urinae colonization in the urine culture. Urogenital disorders were present in 12 patients. Additional pathogens were detected in 13 patients. Recurrence of detection during our study period was observed in four (20%) patients. Conclusion: Beyond malodorous urine, A. urinae detection is associated with more severe presentations including UTI in the paediatric population. Pre-existing urogenital disorders were frequent, and therefore, a nephro-urological investigation should be considered in all cases of A. urinae detection in the paediatric population. What is Known: • Aerococcus urinae (A. urinae) is known to be a common pathogen in the geriatric population, causing urinary tract infection (UTI), sepsis, and endocarditis, predominantly in female patients. • In the paediatric population, A. urinae is mainly described as a low-grade pathogen. Some case reports describe A. urinae as the cause of extraordinary malodorous urine in otherwise healthy boys. What is New: • Beyond malodorous urine, A. urinae detection is associated with more severe presentations including UTI in the paediatric population. • A. urinae was mainly detected in boys with pre-existing urogenital disorders; therefore, a nephro-urological investigation should be considered in cases of A. urinae detection in the paediatric population.
Topics: Aged; Male; Humans; Child; Female; Retrospective Studies; Anti-Bacterial Agents; Microbial Sensitivity Tests; Urinary Tract Infections; Aerococcus; Sepsis; Endocarditis; Urinary Tract; Gram-Positive Bacterial Infections
PubMed: 36472648
DOI: 10.1007/s00431-022-04730-2 -
Journal of Medical Case Reports Nov 2022Aerococcus 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...
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.
Topics: Male; Humans; Aged, 80 and over; Aerococcus; Abscess; Gram-Positive Bacterial Infections; Endocarditis, Bacterial; Endocarditis; Urinary Tract Infections; Stomatognathic Diseases
PubMed: 36397095
DOI: 10.1186/s13256-022-03564-8 -
Cureus Oct 2022A 75-year-old male, with a past medical history of chronic kidney disease stage 3 (CKD3) and a recent diagnosis of bilateral hydronephrosis and Foley catheter...
A 75-year-old male, with a past medical history of chronic kidney disease stage 3 (CKD3) and a recent diagnosis of bilateral hydronephrosis and Foley catheter placement, presented to the emergency department for fever. Blood cultures grew Aerococcus urinae. Transthoracic echo (TTE) demonstrated thickened aortic valve leaflets with perforation, multiple echo densities, and severe aortic regurgitation. The patient developed decompensated congestive heart failure and cardiogenic shock. En route to surgery for emergent aortic valve replacement, the patient lost pulse and was resuscitated. The patient was subsequently transferred to the ICU where the family decided to initiate comfort care measures. This case highlights the importance and necessity of the prompt diagnosis and treatment of infective endocarditis and makes the reader aware of uncommon and rare organisms, such as Aerococcus urinae, as potential etiologies.
PubMed: 36337828
DOI: 10.7759/cureus.29853 -
The American Journal of Case Reports Oct 2022BACKGROUND Aerococcus species are a rare cause of endocarditis. Micro-organism identification and antibiotic choice can pose significant management challenges to...
BACKGROUND Aerococcus species are a rare cause of endocarditis. Micro-organism identification and antibiotic choice can pose significant management challenges to clinicians who care for patients with this infection. Aerococcus is a gram-positive micro-organism which is commonly misidentified because it shares many similarities with streptococcus and enterococcus species. Aerococcus urinae is usually found to cause urinary tract infections and occurs more frequently in patients with structural urinary tract abnormalities associated with urethral and ureteral obstruction such as kidney stones, phimosis, and prostate hyperplasia. However, it is reported to rarely cause endocarditis. CASE REPORT A 48-year-old man with a history of cocaine abuse and right hip replacement presented to our emergency department with acute encephalopathy. Through a complicated hospital course, he was found to be septic and the bacteria were initially misidentified as an alpha-hemolytic strep before being correctly identified as Aerococcus urinae. He was found to have multiple cerebral, likely septic, embolic infarcts and aortic valve endocarditis. Identification of the micro-organism on blood cultures was challenging, as were decisions about antibiotic choice. He died despite efforts of a multidisciplinary care team. CONCLUSIONS Our case highlights a unique case of Aerococcus endocarditis and shows the difficulty in initially identifying the bacteria. To our knowledge this is the first case reported in the setting of substance abuse. It also highlights the lack of appropriate guideline-directed therapy with regards to antibiotic choices in this group of patients, emphasizing the importance of further research in this regard.
Topics: Aerococcus; Anti-Bacterial Agents; Aortic Valve; Endocarditis; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Sepsis
PubMed: 36251625
DOI: 10.12659/AJCR.937596 -
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 -
International Urogynecology Journal May 2023We sought to evaluate patient satisfaction with a novel multiplex PCR UTI home collection kit for symptomatic UTI in a urogynecologic population. We secondarily sought...
INTRODUCTION AND HYPOTHESIS
We sought to evaluate patient satisfaction with a novel multiplex PCR UTI home collection kit for symptomatic UTI in a urogynecologic population. We secondarily sought to characterize reported uropathogens and resistance profiles of uropathogens in this population. We hypothesized that patients would be satisfied.
METHODS
This was a cross-sectional study of women who were surveyed later about their experience undergoing evaluation for a UTI with a home UTI test at a large tertiary care urogynecology practice in 2020. Symptomatic patients were sent a home UTI kit. We assessed patient satisfaction at a later time with a 5-point Likert scale and collected baseline information. The primary outcome was patient satisfaction with this experience. Secondary outcomes included type and number of uropathogens on testing.
RESULTS
A total of 30 patients [73% white race, mean age 71.9 (SD 12.0) years] were surveyed. Patients responded with a mean score of 4.7/5 to all satisfaction questions. Overall, 86% (26/30) of patients would choose this test again. Of those asked if they would choose this test again outside of the COVID-19 pandemic, 86% responded affirmatively. The most common symptoms reported included dysuria (53%), urgency (37%) and frequency (30%). The most common pathogens identified included Escherichia coli (70%), Enterococcus faecalis (60%) and Aerococcus urinae (43%).
CONCLUSIONS
Patients were satisfied with home UTI PCR testing and the majority would choose this option again. Home UTI PCR testing revealed common uropathogens for a population with a high proportion of recurrent UTI, but additional research comparing home versus in-office urine PCR testing is necessary.
Topics: Aged; Female; Humans; Cross-Sectional Studies; Escherichia coli; Pandemics; Patient Outcome Assessment; Patient Satisfaction; Personal Satisfaction; Polymerase Chain Reaction; Urinary Tract Infections; Reagent Kits, Diagnostic
PubMed: 35943561
DOI: 10.1007/s00192-022-05309-z -
Cureus Jun 2022is a rare cause of urinary tract infection (UTI) seen in elderly males with multimorbidity. Incidence is estimated between 0.15 and 0.8%. This organism is frequently...
is a rare cause of urinary tract infection (UTI) seen in elderly males with multimorbidity. Incidence is estimated between 0.15 and 0.8%. This organism is frequently misidentified for other gram-positive species. Missed or delayed diagnosis of UTI can lead to systemic infection with high morbidity and potential mortality. We present a classic case of UTI in a 91-year-old male with multiple comorbidities, including heart failure, diabetes mellitus, and metastatic prostate carcinoma. Empiric therapy with nitrofurantoin was unsuccessful, but intravenous ceftriaxone and bladder catheterization resulted in rapid symptomatic improvement. Variable antimicrobial sensitivities and resistance have been reported for . Therefore, antimicrobial resistance testing should be performed for all patients with infections.
PubMed: 35911344
DOI: 10.7759/cureus.26379 -
Proceedings (Baylor University. Medical... 2022is an alpha-hemolytic, gram-positive coccus that is responsible for 54/1,000,000 cases of all urinary tract infections. Risk factors include male gender, advanced age,...
is an alpha-hemolytic, gram-positive coccus that is responsible for 54/1,000,000 cases of all urinary tract infections. Risk factors include male gender, advanced age, and genitourinary tract abnormalities. It has often been misidentified as or due to its morphological similarities. Fewer than 50 cases of infective endocarditis have been reported, most affecting the mitral or aortic valve. We present the case of a 61-year-old woman who presented with recurrent fevers and worsening dyspnea on exertion and was found to have bacteremia. A transesophageal echocardiogram showed evidence of moderate tricuspid valve regurgitation and vegetations involving its posterior and septal leaflets. The patient was successfully treated with intravenous penicillin G for 6 weeks. She was not deemed a candidate for cardiac surgery.
PubMed: 35754564
DOI: 10.1080/08998280.2022.2054042