Clinical significance and antimicrobial susceptibilities of Aerococcus sanguinicola and Aerococcus urinae

Shelton-Dodge, Kelsey; Vetter, Emily A.; Kohner, Peggy C.; Nyre, Lisa M.; Patel, Robin

doi:10.1016/j.diagmicrobio.2010.09.001

Cited by 35 publications

(34 citation statements)

References 14 publications

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“…As fluoroquinolones are commonly used for the empirical treatment of urinary tract infections, physicians should be aware that resistance to this class of antimicrobials may occur in vitro in A. urinae, although no clinical data are available that demonstrate the significance of this phenotype in vivo for patients treated with fluoroquinolones. Skov and colleagues (18) found 89% susceptibility (MIC Յ 1 g/ml) to ciprofloxacin among 56 A. urinae isolates, and Shelton-Dodge et al found 67% susceptibility (MIC Յ 2 g/ ml) to levofloxacin among 30 A. urinae isolates tested by agar dilution (1).…”

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confidence: 99%

“…Because of the low frequency of infections due to A. urinae, there are limited clinical outcome data described in the literature. The appropriateness of the interpretive criteria suggested in this study and the antimicrobials chosen for testing were therefore assessed based on the MIC distributions found in the present study and the literature (1,2,18), such that the breakpoints did not bisect MIC distributions. Adapting breakpoints from a similar organism group with similar MIC distributions is a strategy consistent with that applied to several organisms included in the CLSI M45-A2 document (29).…”

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In Vitro Antimicrobial Susceptibility of Aerococcus urinae

Humphries

2014

J Clin Microbiol

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Aerococcus urinae may cause urinary tract infections, bacteremia, and endocarditis. No standardized susceptibility test methods or interpretive criteria have been proposed for this organism. This study reports the MIC results for 128 A. urinae isolates tested by broth microdilution. The isolates had low MICs to amoxicillin, cefotaxime, ceftriaxone, doxycycline, linezolid, meropenem, penicillin, rifampin, tetracycline, trimethoprim-sulfamethoxazole, and vancomycin. However, 55% of the isolates had MICs to clindamycin of >0.25 g/ml, 44% had MICs to erythromycin of >0.25 g/ml, and 16% had MICs to levofloxacin of >2 g/ml.A erococcus urinae is a Gram-positive coccus that colonizes the human urinary tract and may cause symptomatic urinary tract infections (1-3). Importantly, A. urinae is also described as the cause of invasive infections, such as endocarditis and bacteremia (4-17), and has been reported to demonstrate resistance to a variety of commonly used classes of antimicrobial agents, in particular, trimethoprim-sulfamethoxazole (SXT) and fluoroquinolones (18,19). In the laboratory, A. urinae, particularly when isolated from urine, may be misidentified as an alpha-hemolytic Streptococcus strain due to several shared phenotypic properties, including colony morphology and negative catalase reactions (13,20). However, improved diagnostic technologies, such as matrixassisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (21), are allowing clinical laboratories to correctly identify A. urinae with increasing frequency.The lack of standardized susceptibility test methods and interpretive criteria for Aerococcus spp. are problematic for clinical laboratories and clinicians. There are a limited number of published studies that address susceptibility testing of A. urinae, and these usually include a small number of isolates. A variety of test methods have been reported, and interpretive criteria for streptococci (2), staphylococci (22), and even enterococci (R.M.H., personal observation) have been applied. The Clinical and Laboratory Standards Institute (CLSI) has described a broth microdilution MIC test for Streptococcus pneumoniae and Streptococcus spp. that utilizes Mueller-Hinton broth supplemented with 2.5 to 5% lysed horse blood (23). In this study, we report the results of antimicrobial susceptibility testing for a collection of 128 unique A. urinae isolates, performed using this method, against 14 antimicrobial agents. Based on information in the literature and the MIC distributions obtained in our study, we propose the use of CLSI viridans group streptococci MIC interpretive criteria for A. urinae.All A. urinae strains were isolated from urine specimens at concentrations of Ն10 5 CFU/ml between January 2005 and December 2013 by the UCLA Health System Clinical Microbiology Laboratory. Identification was performed using the API 20 Strep (bioMérieux, Durham, NC). Antimicrobial susceptibility testing was performed at the time of isolation using the CLSI reference broth microdilution (BM...

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In Vitro Antimicrobial Susceptibility of Aerococcus urinae

Humphries

2014

J Clin Microbiol

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“…4 Sulfa resistance was often described for A. urinae, but recent literature reports most strains as susceptible to trimethoprim-sulfamethoxazole. 5 Rasmussen 1 suggests nitrofurantoin or fosfomycin for uncomplicated A. urinae UTI, and amoxicillin or a fluoroquinolone for complicated UTI.…”

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Hip abscess due to Aerococcus urinae in a man with paraplegia: case report

et al. 2013

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“…Aerococcus viridans was the first aerococcal species to be identified but is a rare cause of human infections [2,11]. The most common site of isolation for both A. urinae and A. sanguinicola is human urine [3,12,13,14,15,16].…”

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Clinical and microbiological features of infective endocarditis caused by aerococci

et al. 2015

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Aerococci are increasingly recognized as causative agents in human infective endocarditis (IE). Information on the clinical presentation and the prognosis of IE caused by aerococci is limited. We employed the Swedish Registry of Infective Endocarditis (SRIE) to identify cases of aerococcal IE. The medical records were analysed and comparisons with cases of IE caused by other pathogens reported to the SRIE were made. Available bacterial isolates were reanalysed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) and the aetiology was confirmed to be Aerococcus urinae in fourteen cases and Aerococcus sanguinicola in two cases. The bacteria were sensitive to penicillin and Etest-based synergy testing and time-kill experiments suggested synergy between penicillin and gentamicin towards some isolates. The patients had a median age of 79 years, which was significantly higher than that of patients with IE caused by streptococci or Staphylococcus aureus. Most patients with IE caused by aerococci had underlying urinary tract diseases and many presented with symptoms suggesting a urinary tract focus of the infection. Despite the fact that many patients with aerococcal IE presented with severe sepsis, ICU treatment was needed only in one patient and there was no fatality. Valve exchange surgery was needed in four of sixteen patients with aerococcal IE and embolization was seen in three patients. This report is by far the largest on aerococcal IE and suggests that the prognosis of aerococcal IE is relatively favourable despite the fact that the patients are old and have significant comorbidities.

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Clinical significance and antimicrobial susceptibilities of Aerococcus sanguinicola and Aerococcus urinae

Cited by 35 publications

References 14 publications

In Vitro Antimicrobial Susceptibility of Aerococcus urinae

In Vitro Antimicrobial Susceptibility of Aerococcus urinae

Hip abscess due to Aerococcus urinae in a man with paraplegia: case report

Clinical and microbiological features of infective endocarditis caused by aerococci

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