Aerococcus urinae — significance of detection in the paediatric urinary tract: a case series

Abstract

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.

Beyond the usual suspects: emerging uropathogens in the microbiome age

“…Risk factors for invasive infections include older age and comorbid genitourinary diseases (121,124,128). In pediatric settings, A. urinae has been reported as a cause for extraordinary malodorous urine in boys with comorbid urogenital disorders as a risk factor (129,130). Malodorous urine has been documented in adult patients as well, having been described as ammoniacal and "socially disabling" (120,131).…”

Aerococcus Urinae Infection Causing Malodorous Urine in a Child: A Case Report

“…Aerococcus urinae (A. urinae) infection is a rare occurrence among pediatric patients [1]. Males are predominately affected in this age group [1].…”

“…Aerococcus urinae (A. urinae) infection is a rare occurrence among pediatric patients [1]. Males are predominately affected in this age group [1]. The most common clinical manifestations in pediatric cases include asymptomatic bacteriuria and malodorous urine, although more severe presentations such as urinary tract infections and endocarditis can occur [1][2][3].…”

“…Males are predominately affected in this age group [1]. The most common clinical manifestations in pediatric cases include asymptomatic bacteriuria and malodorous urine, although more severe presentations such as urinary tract infections and endocarditis can occur [1][2][3]. Currently, there are no established guidelines for optimal management strategies regarding the choice of antibiotics and duration of treatment in pediatric patients.…”

“…Currently, there are no established guidelines for optimal management strategies regarding the choice of antibiotics and duration of treatment in pediatric patients. Recurrence is a concern, especially among patients with underlying urogenital disorders [1]. Overall, A. urinae is considered an unusual low-grade pathogen in the pediatric population, but it can lead to serious invasive infections.…”