Management and treatment of Aerococcus bacteremia and endocarditis

Abstract

We describe our multicenter experience on diagnosis and management of Aerococcus bacteremia including the susceptibility profile of Aerococcus species and a suggested algorithm for clinicians. Methods: Retrospective study of all patients with positive blood cultures for Aerococcus species from January 2005 to July 2020 in our institution with clinical data and susceptibility profile. Data were collected from both electronic health record and clinical microbiology laboratory database. Results: There were 219 unique isolates with only the susceptibility profiles available, while 81 patients had clinical information available. Forty-nine of those cases were deemed as true bloodstream infection and the rest were of unclear clinical significance. Cases of endocarditis (n = 7) were high-grade, monomicrobial bacteremia caused by Aerococcus urinae. Patients with endocarditis were younger (66 vs 80 p < 0.05). The risk for endocarditis was higher if duration of symptoms was longer than 7 days (OR 105, 95% CI: 5À2271), or if there were septic emboli (OR 71, 95% CI: 3-1612). A DENOVA score cutoff of ! 3 was 100% sensitive and 89% specific in detecting endocarditis. The 30-day and 3-month all-cause mortality for bacteremia was 17% and 24%, respectively. Six out of seven patients with endocarditis survived. Conclusions: Antibiotic regimen for aerococcal bloodstream infections and endocarditis should be guided by species identification and antimicrobial susceptibility testing. DENOVA scoring system's performance in this study is more congruent to other studies. Hence, it can be used as an adjunctive tool in assessing the need for echocardiogram to rule out endocarditis. In our experience, two and four weeks of treatment for bloodstream infections and endocarditis, respectively, had good outcomes.

Clinical and microbiological characterization of Aerococcus urinae bacteraemias at Helsinki metropolitan area, Finland

“…In our cohort, the 22% mortality rate was somewhat higher than reported previously [1,2,4,7,14]. In other studies, 30-day mortality has ranged between 6 and 17%.…”

Emerging Presence of Culturable Microorganisms in Clinical Samples of the Genitourinary System: Systematic Review and Experience in Specialized Care of a Regional Hospital

“…This genus is usually susceptible to beta-lactams, the antibiotic of choice, and to vancomycin, which is reserved for allergic patients in combination with gentamycin [ 32 ]. However, A. viridans has elevated minimum inhibitory concentration (MIC) values for penicillin and aminoglycosides, and resistance to vancomycin has been reported [ 33 , 34 ]. Both the review and our laboratory results evidence elevated MICs for nitrofurantoin, fluoroquinolones, and cotrimoxazole [ 28 ].…”

Aerococcus Urinae Endocarditis: A Case Report and Literature Review

“…In contrast to the individual cases mentioned previously, a prior comprehensive review of Aerococcus urinae infective endocarditis was completed by Yabes et al in 2018, which compiled a tabulated report of 43 cases of Aerococcus urinae infective endocarditis [12,13]. A subsequent literature search demonstrated seven additional cases of Aerococcus urinae infective endocarditis described in Tai et al, which has brought the total number of known cases to 50 (Table 3) [14]. The average age among these 50 cases was noted to be 71 years of age, with 80% of cases noted to be in male patients.…”