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

Goetz, Lance L.; Powell, D J; Castillo, Teodoro; Adkins, L; Klausner, Adam P.; Gater, David R.

doi:10.1038/sc.2013.88

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…The fatality rate of A. urinae is particularly high in cases of endocarditis, which might be associated with a high rate of embolization [6]. After the report of Goetz et al [7], our is the second case of osteoarticular infection due to A. urinae. However, in 2011, a tibia osteitis due to A. urinae was documented in our hospital in a patient following a bone graft ( Fig.…”

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confidence: 70%

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Diagnosis of Aerococcus urinae infections: Importance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry and broad-range 16S rDNA PCR

Opota

Prod’hom

Andreutti-Zaugg

et al. 2016

Clinical Microbiology and Infection

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An increasing number of clinical reports are associating Aerococcus urinae with severe infections such as endocarditis, joint infections, and osteomyelitis. A. urinae identification has been hampered for years by morphotype ambiguity with streptococci or coagulase-negative staphylococci as this is a Grampositive α-haemolytic bacteria able to grow in pairs and clusters. In our university hospital, A. urinae was rarely identified before 2009. The identification rate of A. urinae started to increase significantly after the introduction of a matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) system (Bruker Daltonics, Leipzig, Germany) in our diagnostic laboratory in May 2009 ( Fig. 1) [1,2]. It is noteworthy that five of 11 severe infections due to A. urinae that we documented (bloodstream infections, endocarditis, and joint infections) occurred in the setting of negative cultures, and were documented by the use of eubacterial 16S rDNA PCR. The recent literature, our data and the two cases that we describe herein suggest that the prevalence of A. urinae in clinical samples and its pathogenic role might have been underestimated in the pre-molecular diagnostic era.Our first case, a 78-year-old male, presented with persistent fever of 39°C that had lasted for 2 weeks, and that had not responded to 5 days of oral amoxicillin-clavulanate treatment. Cardiac auscultation revealed a systolic heart murmur with axillary irradiations. Intravenous amoxicillin-clavulanate was administered empirically after several blood cultures that remained sterile. Transoesophageal echocardiography revealed a 17-mm mitral valve vegetation and severe valvular insufficiency, which required rapid valvular replacement. The valve showed acute necrotizing inflammation, confirming the diagnosis of endocarditis. As the valve culture remained sterile, we performed a broad-range 16S rRNA gene PCR [3], which revealed the presence of A. urinae, a pathogen that has already been reported in culture-negative endocarditis [4,5]. The Aerococcus strains isolated in our diagnostic laboratory were generally susceptible to beta-lactam antibiotics (of 176 strains, five exhibited intermediate susceptibility to ceftriaxone and two were resistant to cefriaxone). A combination of amoxicillin for 6 weeks and gentamicin for 2 weeks was given, with a favourable clinical evolution.The second patient was a 60-year-old woman who was hospitalized 2 days after a high fever with signs of hip prosthetic joint infection. A one-stage exchange procedure had been performed 4 months earlier because of mechanical failure. She was receiving chronic methotrexate therapy for rheumatoid arthritis, and daily doxycycline for hidradenitis suppurativa. There was no evidence of urinary tract or cardiac infection, and the blood cultures remained sterile. A debridement with retention strategy was chosen. The culture of the sonicated mobile parts of the prosthesis remained sterile, but two of the five perioperative biopsies became positive for Gram-posit...

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confidence: 70%

“…The fatality rate of A. urinae is particularly high in cases of endocarditis, which might be associated with a high rate of embolization [6]. After the report of Goetz et al [7], our is the second case of Clin Microbiol Infect 2016; 22: e1-e2 Clinical Microbiology and Infection…”

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confidence: 86%

Diagnosis of Aerococcus urinae infections: Importance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry and broad-range 16S rDNA PCR

Opota

Prod’hom

Andreutti-Zaugg

et al. 2016

Clinical Microbiology and Infection

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“…Other, less common, presentations of invasive infection are peritonitis in patients receiving peritoneal dialysis [45,46], vertebral osteomyelitis [2,47], soft-tissue infections in the genital area [2,48,49], postpartum infection [50], odontogenic infection [51], joint infections [17,52] and postoperative infection [53].…”

Section: Other Invasive Aerococcal Infectionsmentioning

confidence: 99%

Aerococcus : an increasingly acknowledged human pathogen

Rasmussen

2016

Clinical Microbiology and Infection

145

140

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Aerococci have often been misidentified as streptococci in microbiology laboratories, leading to an underestimation of these bacteria as causes of human infections. An increased awareness of aerococci and the introduction of matrix-assisted laser desorption ionization time-of-flight mass spectrometry, has led to an increased isolation of Aerococcus urinae and Aerococcus sanguinicola from human urine and blood. The two species are found in human urine and can cause urinary tract infections (UTI). Aerococcus urinae can, in older males with underlying urinary tract conditions, cause invasive infections such as urosepsis or infective endocarditis. The prognosis of invasive aerococcal infections appears to be relatively favourable despite the old age of patients and their many comorbidities. Though clinical breakpoints are still not in place, aerococci seem to be sensitive to penicillins, carbapenems and vancomycin. There is synergy between penicillin and aminoglycosides against some A. urinae isolates and this combination is often used in aerococcal infective endocarditis. The treatment of complicated aerococcal UTI is not obvious as many isolates are resistant to fluoroquinolones. In addition, A. urinae is resistant to sulphamethoxazole, and there are methodological problems in the determination of trimethoprim sensitivity. In complicated UTI, ampicillin is probably a safe treatment option, whereas nitrofurantoin is probably effective in uncomplicated UTI. Treatment studies in aerococcal infections are needed as is a better understanding of the natural niches for aerococci and the pathogenesis and clinical course of aerococcal infections.

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“…That patient underwent incision and debridement and the causative pathogen was found to be A. urinae . It was determined that the A. urinae was unlikely to be a contaminant and most likely seeded the hip from a bladder source [13]. In 2002, Park et al report a case of a 48 year old male with superior vena cava syndrome caused by a para-aortic abscess that was found to have Aerococcus viridans after the patient underwent orthotopic heart transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Abscess infections due to Aerococcus species are exceedingly rare. To date, there is one case of a hip abscess due to Aerococcus urinae [13] and another case of a para-aortic abscess formation post-heart transplantation with Aerococcus viridians [14]. We report an unusual case of a perineal abscess where the causative pathogen isolated was Aerococcus urinae .…”

Section: Introductionmentioning

confidence: 92%

A rare case of perineal abscess caused by aerococcus urinae

Niknam

Mankame

et al. 2017

IDCases

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Aerococcus urinae, a previously misidentified pathogen, has become increasingly recognized to cause severe and even fatal infections. Aerococcus-related perineal abscess infections have not previously been reported in the literature. Most reported cases of infections caused by Aerococcus are urinary tract infections, bacteremia, and even rare cases of endocarditis. We report an unusual case of a perineal abscess caused by Aerococcus urinae.

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

Cited by 8 publications

References 4 publications

Diagnosis of Aerococcus urinae infections: Importance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry and broad-range 16S rDNA PCR

Diagnosis of Aerococcus urinae infections: Importance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry and broad-range 16S rDNA PCR

Aerococcus : an increasingly acknowledged human pathogen

A rare case of perineal abscess caused by aerococcus urinae

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