Skip to main content

Advertisement

SpringerLink
Log in

Clinical and microbiological features of infective endocarditis caused by aerococci

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

To define the clinical presentation of aerococcal infective endocarditis (IE) and the prevalence of synergy between penicillin and gentamicin on aerococcal isolates.

Methods

Cases of aerococcal IE between 2002 and 2014 were identified in the Swedish Registry of Infective Endocarditis (SRIE). MALDI-TOF MS was used to confirm species determination. The medical records were analysed and compared to cases reported to the SRIE caused by other pathogens.

Results

Sixteen cases of aerococcal IE, fourteen with Aerococcus urinae and two with Aerococcus sanguinicola, were confirmed. Etest-based methods and time-kill experiments suggested synergy between penicillin and gentamicin towards seven of fifteen isolates. The patients with aerococcal IE were significantly older than those with streptococci or Staphylococcus aureus IE. Most of the patients had underlying urinary tract diseases or symptoms suggesting a urinary tract focus of the infection. Seven patients with aerococcal IE presented with severe sepsis but ICU treatment was needed only in one patient and there was no fatality. Valve exchange surgery was needed in four patients and embolization was seen in three patients.

Conclusions

This report is the largest on aerococcal IE and suggests that the prognosis is relatively favourable despite the fact that the patients are old and have significant comorbidities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Parker MT, Ball LC. Streptococci and aerococci associated with systemic infection in man. J Med Microbiol. 1976;9:275–302.

    Article  CAS  PubMed  Google Scholar 

  2. Rasmussen M. Aerococci and aerococcal infections. J Infect. 2012;6:467–474.

  3. Cattoir V, Kobal A, Legrand P. Aerococcus urinae and Aerococcus sanguinicola, two frequently misidentified uropathogens. Scand J Infect Dis. 2010;42:775–80.

    Article  CAS  PubMed  Google Scholar 

  4. Senneby E, Nilson B, Petersson AC, Rasmussen M. Matrix-assisted laser desorption ionization-time of flight mass spectrometry is a sensitive and specific method for identification of aerococci. J Clin Microbiol. 2013;51:1303–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Christensen JJ, Dargis R, Hammer M, Justesen US, Nielsen XC, Kemp M, et al. Matrix-assisted laser desorption ionization-time of flight mass spectrometry analysis of Gram-positive, catalase-negative cocci not belonging to the Streptococcus or Enterococcus genus and benefits of database extension. J Clin Microbiol. 2012;50:1787–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Christensen JJ, Jensen IP, Faerk J, Kristensen B, Skov R, Korner B. Bacteremia/septicemia due to Aerococcus-like organisms: report of seventeen cases. Danish ALO Study Group. Clin Infect Dis. 1995;21:943–7.

    Article  CAS  PubMed  Google Scholar 

  7. Senneby E, Petersson AC, Rasmussen M. Clinical and microbiological features of bacteraemia with Aerococcus urinae. Clin Microbiol Infect. 2012;18:546–50.

    Article  CAS  PubMed  Google Scholar 

  8. de Jong MFC, Soetekouw R, ten Kate RW, Veenendaal D. Aerococcus urinae: severe and fatal bloodstream infections and endocarditis. J Clin Microbiol. 2010;48:3445–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ibler K, Truberg Jensen K, Ostergaard C, Sönksen UW, Bruun B, Schønheyder HC, et al. Six cases of Aerococcus sanguinicola infection: clinical relevance and bacterial identification. Scand J Infect Dis. 2008;40:761–5.

    Article  CAS  PubMed  Google Scholar 

  10. Senneby E, Eriksson B, Fagerholm E, Rasmussen M. Bacteremia with Aerococcus sanguinicola: case series with characterization of virulence properties. Open Forum Infect Dis. 2014;1:ofu025.

  11. Williams RE, Hirch A, Cowan ST. Aerococcus, a new bacterial genus. J Gen Microbiol. 1953;8:475–80.

    Article  CAS  PubMed  Google Scholar 

  12. Rasmussen M. Aerococcus viridans is not a matter of opinion. Comment on: an unusual microorganism, Aerococcus viridans, causing endocarditis and aortic valvular obstruction due to a huge vegetation (Turk Kardiyol Dern Ars 2011;39:317-319). Turk Kardiyol Dern Ars. 2012;40:112.

    PubMed  Google Scholar 

  13. Christensen JJ, Vibits H, Ursing J, Korner B. Aerococcus-like organism, a newly recognized potential urinary tract pathogen. J Clin Microbiol. 1991;29:1049–53.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Sierra-Hoffman M, Watkins K, Jinadatha C, Fader R, Carpenter JL. Clinical significance of Aerococcus urinae: a retrospective review. Diagn Microbiol Infect Dis. 2005;53:289–92.

    Article  PubMed  Google Scholar 

  15. Schuur PM, Kasteren ME, Sabbe L, Vos MC, Janssens MM, Buiting AG. Urinary tract infections with Aerococcus urinae in the south of The Netherlands. Eur J Clin Microbiol Infect Dis. 1997;16:871–5.

    Article  CAS  PubMed  Google Scholar 

  16. Shelton-Dodge K, Vetter EA, Kohner PC, Nyre LM, Patel R. Clinical significance and antimicrobial susceptibilities of Aerococcus sanguinicola and Aerococcus urinae. Diagn Microbiol Infect Dis. 2011;70:448–51.

    Article  CAS  PubMed  Google Scholar 

  17. Senneby E, Petersson AC, Rasmussen M. Epidemiology and antibiotic susceptibility of aerococci in urinary cultures. Diagn Microbiol Infect Dis. 2015;81:149–51.

    Article  CAS  PubMed  Google Scholar 

  18. Rasmussen M. Which Aerococcus? comment on: an unusual microorganism, Aerococcus viridans, causing endocarditis and aortic valvular obstruction due to a huge vegetation (turk kardiyol dern ars 2011;39:317-9). Turk Kardiyol Dern Ars. 2011;39:630.

    PubMed  Google Scholar 

  19. Chen L-Y, Yu W-C, Huang S-H, Lin M-L, Chen T-L, Fung C-P, et al. Successful treatment of Aerococcus viridans endocarditis in a patient allergic to penicillin. J Microbiol Immunol Infect. 2012;45:158–60.

    Article  PubMed  Google Scholar 

  20. Skov R, Christensen JJ, Korner B, Frimodt-Møller N, Espersen F. In vitro antimicrobial susceptibility of Aerococcus urinae to 14 antibiotics, and time-kill curves for penicillin, gentamicin and vancomycin. J Antimicrob Chemother. 2001;48:653–8.

    Article  CAS  PubMed  Google Scholar 

  21. Zbinden R, Santanam P, Hunziker L, Leuzinger B, von Graevenitz A. Endocarditis due to Aerococcus urinae: diagnostic tests, fatty acid composition and killing kinetics. Infection. 1999;27:122–4.

    Article  CAS  PubMed  Google Scholar 

  22. Ternhag A, Cederström A, Törner A, Westling K. A nationwide cohort study of mortality risk and long-term prognosis in infective endocarditis in Sweden. PLoS One. 2013;8:e67519.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Matuschek E, Brown DFJ, Kahlmeter G. Development of the EUCAST disk diffusion antimicrobial susceptibility testing method and its implementation in routine microbiology laboratories. Clin Microbiol Infect. 2014;20:O255–66.

    Article  CAS  PubMed  Google Scholar 

  24. Pankey GA, Ashcraft DS, Dornelles A. Comparison of 3 Etest(®) methods and time-kill assay for determination of antimicrobial synergy against carbapenemase-producing Klebsiella species. Diagn Microbiol Infect Dis. 2013;77:220–6.

    Article  CAS  PubMed  Google Scholar 

  25. Weinstein AJ, Moellering RC. Studies of cephalothin: aminoglycoside synergism against enterococci. Antimicrob Agents Chemother. 1975;7:522–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Sunnerhagen T, Hammarlund P, Rasmussen M. A case of suspected infective endocarditis with Lactococcus garvieae: lack of in vitro synergy between ampicillin and gentamicin. JMM Case Rep. 2015;2(1):e000018. doi:10.1099/jmmcr.0.000018.

  27. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994;96:200–9.

    Article  CAS  PubMed  Google Scholar 

  28. Rasmussen M. Aerococci: hard to find and classify. Rev Argent Microbiol. 2011;43:312 (authorreply312–3).

Download references

Acknowledgments

This work was supported by the Swedish Government Fund for Clinical Research (ALF), the Royal Physiographic Society in Lund, and the foundations of Marianne and Marcus Wallenberg, Groschinski, Crafoord, and Österlund. Dr Malin Inghammar is acknowledged for important discussions. The authors acknowledge the kind help from all participating clinical microbiology laboratories and infectious diseases clinics. The authors have no conflicting interests to declare. Part of this work was presented at the ISCVID 2013 congress, Dubrovnik, Croatia.

Author information

Authors and Affiliations

  1. Division of Infection Medicine, Department of Clinical Sciences, Lund University, Tornavägen 10, BMC B14, 221 84, Lund, Sweden

    Torgny Sunnerhagen & Magnus Rasmussen

  2. Clinical Microbiology, Labmedicin, Region Skåne, Lund, Sweden

    Bo Nilson

  3. Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden

    Bo Nilson

  4. Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden

    Lars Olaison

  5. Swedish Registry of Infective Endocarditis, Swedish Society of Infectious Diseases, Gothenburg, Sweden

    Lars Olaison

Authors
  1. Torgny Sunnerhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bo Nilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars Olaison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Magnus Rasmussen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Magnus Rasmussen.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sunnerhagen, T., Nilson, B., Olaison, L. et al. Clinical and microbiological features of infective endocarditis caused by aerococci. Infection 44, 167–173 (2016). https://doi.org/10.1007/s15010-015-0812-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-015-0812-8

Keywords

Search

Navigation