Aerococcus urinae: An Emerging Cause of Urinary Tract Infection in Older Adults with Multimorbidity and Urologic Cancer

Higgins, Andrew; Garg, Tullika

doi:10.1016/j.eucr.2017.03.022

Cited by 25 publications

(23 citation statements)

References 5 publications

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“…AU is a rare pathogen, first isolated in 1953 found in lobsters and thought to be of no clinical significance. It was until 1967 when it was first described to cause infection in humans [1]. This organism is a gram-positive, catalase-negative growing coccus in clusters that belongs to a bacterial group referred to as Aerococcus-like organisms (ALO) [2].…”

Section: Discussionmentioning

confidence: 99%

“…Due to difficulties in the biochemical identification, the incidence of infections with this microorganism has likely been underestimated. Currently, it is thought to be the cause of 0.15 to 0.54% of UTIs [1]; additionally, it is responsible for 0.03 to 0.05% of blood stream infections (BSI). There is not enough data regarding the incidence of AU endocarditis as there have been only 45 reports in English literature.…”

Section: Discussionmentioning

confidence: 99%

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Mitral Valve Endocarditis with Perforation from a Urinary Source: An Unusual Case and Literature Review

Rodriguez

Lasarcina

Dávila

2019

Case Reports in Cardiology

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Aerococcus urinae (AU) is a rare pathogen, identified as gram-positive, catalase-negative coccus that grows in pairs and clusters which has been reported to mainly cause urinary tract infections (UTI), especially in elderly males. Treatment for this microorganism is usually with beta-lactams although cultures with antibiotic susceptibility testing are imperative. We present a case of AU endocarditis initially treated with IV antibiotics; nevertheless, the patient required emergent mitral valve replacement due to severe mitral insufficiency and perforation. We also present an analysis with high-yield points summarizing epidemiology, risk factors, microbiology, clinical features, diagnostic workup, and management of AU in general and AU endocarditis. Finally, we post a literature review of relevant cases and the impact of different variables associated with it.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mitral Valve Endocarditis with Perforation from a Urinary Source: An Unusual Case and Literature Review

Rodriguez

Lasarcina

Dávila

2019

Case Reports in Cardiology

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“…increased isolation also may reflect improved capacity by laboratories to isolate and speciate fastidious or difficult-to-identify pathogens. The increase in A. urinae is noteworthy (including one isolate from a dialysis unit) as this pathogen is increasingly recognized as an emerging cause of urinary tract infections in older patients with urological disorders [10].…”

Section: Organism Trendsmentioning

confidence: 99%

Surveillance of antimicrobial resistance and evolving microbial populations in Vermont: 2011-2018

Stelling

Read

Fritch

et al. 2020

Expert Review of Anti-infective Therapy

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Objective: This study presents trends in organism isolation and antimicrobial resistance in routine microbiology test results from acute-care hospital microbiology laboratories in Vermont. Methods:The WHO Collaborating Centre for Surveillance of Antimicrobial Resistance captured microbiology test results from acute-care Vermont hospital laboratories to monitor geographic and temporal trends in antimicrobial resistance and emerging microbial threats with the free WHONET software.Results: Data were provided from 12 acute care hospital laboratories from 2011 through 2018 for 318,833 isolates from 148,994 patients (70% female, 74% outpatient, and 63% urine). Significant differences (p<0.05) in age, gender, and antimicrobial susceptibility results (e.g. Escherichia coli and levofloxacin) between outpatient and inpatient isolates were identified with temporal increases in certain species (e.g. Aerococcus urinae) and resistance (e.g. Streptococcus pneumoniae and erythromycin). The use of multi-resistance phenotypes demonstrated significant heterogeneity (p<0.05) in MRSA strains between facilities, for example Staphylococcus aureus resistant to six priority antimicrobials were found in no critical access hospitals (fewer than 25 inpatient beds) but in all non-critical access hospitals. Conclusions:Comprehensive electronic surveillance of antimicrobial resistance utilizing routine clinical microbiology data with free software tools offers early recognition and tracking of emerging community and healthcare resistance threats at the local and state level.

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“…Awareness of A. urinae as an emerging pathogen increased, especially following the advent of MALDI-TOF mass spectrometry techniques that allowed the organism to be discerned from staphylococci and streptococci ( Meletis et al, 2017 ; Cattoir et al, 2010 ). Aerococcus urinae infects both males and females ( Schuur et al, 1997 ), especially those with local or systemic predisposing conditions, such as elderly patients ( Senneby et al, 2015 ) and those with urologic conditions ( Sierra-Hoffman et al, 2005 ), prostatic diseases ( Shelton-Dodge et al, 2011 ), urologic cancer ( Higgins and Garg, 2017 ) or using urinary catheters ( Sierra-Hoffman et al, 2005 ; Yu et al, 2019 ). Aerococcus urinae infections have also been reported, albeit rarely, in younger and apparently otherwise healthy patients ( Yabes et al, 2018 ; Sous et al, 2019 ) and pediatric cases are beginning to emerge ( Sous et al, 2019 ; Qureshi and Patel, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

A mouse model displays host and bacterial strain differences in Aerococcus urinae urinary tract infection

Gilbert

Choi

et al. 2021

Biology Open

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In recent years, the clinical significance of Aerococcus urinae has been increasingly recognized. A. urinae has been implicated in cases of urinary tract infection (UTI; acute cystitis and pyelonephritis) in both male and female patients, ranging from children to older adults. Aerococcus urinae can also be invasive, causing urosepsis, endocarditis, and musculoskeletal infections. Mechanisms of pathogenesis in A. urinae infections are poorly understood, largely due to the lack of an animal model system. In response to this gap, we developed a model of A. urinae urinary tract infection in mice. We compared A. urinae UTI in female C3H/HeN and C57BL/6 mice and compared four clinical isolates of A. urinae isolated from patients with UTI, urgency urinary incontinence, and overactive bladder. Our data demonstrate that host genetic background modulates A. urinae UTI. Female C57BL/6 female mice rapidly cleared the infection. Female C3H/HeN mice, which have inherent vesicoureteral reflux that flushes urine from the bladder up into the kidneys, were susceptible to prolonged bacteriuria. This result is consistent with the fact that A. urinae infections most frequently occur in patients with underlying urinary tract abnormalities or disorders that make them susceptible to bacterial infection. Unlike uropathogens such as E. coli, which cause infection and inflammation both of the bladder and kidneys in C3H/HeN mice, A. urinae displayed tropism for the kidney, persisting in kidney tissue even after clearance of bacteria from the bladder. Aerococcus urinae strains from different genetic clades displayed varying propensities to cause persistent kidney infection. Aerococcus urinae infected kidneys displayed histological inflammation, neutrophil recruitment and increased pro-inflammatory cytokines. These results set the stage for future research that interrogates host-pathogen interactions between A. urinae and the urinary tract.

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Aerococcus urinae: An Emerging Cause of Urinary Tract Infection in Older Adults with Multimorbidity and Urologic Cancer

Cited by 25 publications

References 5 publications

Mitral Valve Endocarditis with Perforation from a Urinary Source: An Unusual Case and Literature Review

Mitral Valve Endocarditis with Perforation from a Urinary Source: An Unusual Case and Literature Review

Surveillance of antimicrobial resistance and evolving microbial populations in Vermont: 2011-2018

A mouse model displays host and bacterial strain differences in Aerococcus urinae urinary tract infection

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