Abstract
Our objective was to assess the incidence of bacteraemic Aerococcus urinae cases at Helsinki metropolitan area, Finland, from a 6-year study period (2013 to 2018) and to further characterize available cases. The study evaluates the outcome of commonly used cefuroxime treatment and determinate a set of A. urinae in vitro antimicrobial susceptibilities for benzylpenicillin, cefuroxime, and ceftriaxone. Clinical records of A. urinae bacteraemic patients were reviewed retrospectively. Antimicrobial susceptibility testing was performed by disk diffusion, gradient test, and broth microdilution for 139–141 clinical A. urinae isolates. Clinical data of 72/77 patients were combined with the in vitro susceptibilities. We found an increasing number of bacteraemic A. urinae cases within 6-year study period (p = 0.01). The patients were mainly elderly males, and all suffered from underlying conditions. A total of 27.3% of cases (21/77) showed polymicrobial blood cultures. Thirty-day mortality was 22.1%. Cefuroxime was the initial empiric antimicrobial agent given for 66/76 of the patients and treatment outcome was favorable for 20/22 patients who received cefuroxime at least up to day 5. All isolates were susceptible to benzylpenicillin and cefuroxime interpreted by EUCAST breakpoints for Aerococci and PK-PD breakpoints, respectively. MIC determinations gave variable results for ceftriaxone, 2.1–2.9% of the isolates were resistant. To conclude, it seems that the number of bacteraemic Aerococcus urinae cases is increasing at Helsinki metropolitan area, Finland, reflecting the growing blood culture sampling. Clinical A. urinae isolates were susceptible to cefuroxime in vitro. Treatment data indicate that empirical cefuroxime started for possibly urinary tract -derived community-acquired bacteraemia covers A. urinae.
Highlights
Aerococcus urinae, a Gram-positive coccus, causes urinary tract infections and invasive infections like bacteraemia and infective endocarditis, especially among the elderly [1–6]
Susceptibility testing of A. urinae isolates for benzylpenicillin, cefuroxime, and ceftriaxone was performed in parallel by three different methods; disk diffusion (Oxoid, Cambridge, UK), gradient tests (Etest, BioMérieux SA, Marcy I’Etoile, France), and broth microdilution (Sensititre, Thermo Fisher Scientific, Pittsburgh, PA.)
We found an increasing number of bacteraemic Aerococcus urinae cases at Helsinki Metropolitan area, Finland
Summary
Aerococcus urinae, a Gram-positive coccus, causes urinary tract infections and invasive infections like bacteraemia and infective endocarditis, especially among the elderly [1–6]. In addition to old age, predisposing factors suggested to be associated with A. urinae bacteraemia are male gender and underlying urological conditions including catheterization [1, 2]. As a newcomer and rare pathogen, A. urinae seems to be an unfamiliar microorganism to most clinicians and the treatment approaches are variable [1, 7]. In Europe, bacteraemic A. urinae infections has been characterized comprehensively only in Sweden [2, 7]. Aging in the human population generates global challenges [8] and the resulting multimorbidity may raise the significance of the emerging pathogens like A. urinae in the future. A proper managing of infections caused by A
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