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Aerococcus urinae, a cause of cystitis with malodorous urine in a child: clinical and microbiological challenges.

ABSTRACT: Introduction. An infection of the lower urinary tract associated with an extremely unpleasant odour due to Aerococcus urinae in an otherwise healthy 5-year-old boy is described herein. Case presentation. Interestingly, imaging examination revealed the presence of a bladder diverticulum. Routine microbiological examination based on Gram staining, colony morphology and catalase reactivity suggested that the responsible pathogen could belong either to staphylococci, ?-haemolytic streptococci or enterococci, which are more common urine isolates. Of note is that the VITEK 2 automated system could not identify the micro-organism. Susceptibility testing showed full sensitivity to ?-lactam antibiotics and resistance to trimethoprim/sulfamethoxazole. The isolate was subjected to 16S rRNA gene sequence analysis because of its unusual characteristics. It was identified as A. urinae and the sequence was deposited in GenBank under the accession number KU207150. Conclusion.A. urinae should be considered as a causative agent of urinary-tract infection associated with malodorous urine.

SUBMITTER: Skalidis T

PROVIDER: S-EPMC5361636 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

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Aerococcus urinae, a cause of cystitis with malodorous urine in a child: clinical and microbiological challenges.

Skalidis Tilemachos T Papaparaskevas Josef J Konstantinou Dimitrios D Kapolou Eleni E Falagas Mathhew E ME Legakis Nicholas N

JMM case reports 20170228 2

Introduction. An infection of the lower urinary tract associated with an extremely unpleasant odour due to Aerococcus urinae in an otherwise healthy 5-year-old boy is described herein. Case presentation. Interestingly, imaging examination revealed the presence of a bladder diverticulum. Routine microbiological examination based on Gram staining, colony morphology and catalase reactivity suggested that the responsible pathogen could belong either to staphylococci, α-haemolyti ...[more]

PMID: 28348806

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Project description:Aerococcus urinae and Aerococcus sanguinicola have been increasingly recognized as causative agents of urinary tract infection (UTI) during the last decade. Nitroxoline achieves high urinary concentrations after oral administration and is recommended in uncomplicated UTI in Germany, but its activity against Aerococcus spp. is unknown. The aim of this study was to assess the in vitro susceptibility of clinical Aerococcus species isolates to standard antibiotics and to nitroxoline. Between December 2016 and June 2018, 166 A. urinae and 18 A. sanguinicola isolates were recovered from urine specimens sent to the microbiology laboratory of the University Hospital of Cologne, Germany. Susceptibility to standard antimicrobials was analyzed by disk diffusion (DD) according to EUCAST methodology, nitroxoline was tested by DD and agar dilution. Susceptibility of Aerococcus spp. to benzylpenicillin, ampicillin, meropenem, rifampicin, nitrofurantoin, and vancomycin was 100% and resistance was documented only against ciprofloxacin (20 of 184; 10.9%). MICs of nitroxoline in A. urinae isolates were low (MIC50/90 1/2 mg/L) while significantly higher MICs were observed in A. sanguinicola (MIC50/90 64/128 mg/L). If the EUCAST nitroxoline breakpoint for E. coli and uncomplicated UTI was applied (16 mg/L), 97.6% of A. urinae isolates would be interpreted as susceptible while all A. sanguinicola isolates would be considered resistant. Nitroxoline demonstrated high activity against clinical A. urinae isolates, but low activity against A. sanguinicola. Nitroxoline is an approved antimicrobial for UTI and could be an alternative oral drug to treat A. urinae urinary tract infection, yet clinical studies are needed to demonstrate this potential in vivo. IMPORTANCE A. urinae and A. sanguinicola have been increasingly recognized as causative agents in urinary tract infections. Currently, there are few data available on the activity of different antibiotics against these species and no data on nitroxoline. We demonstrate that clinical isolates in Germany are highly susceptible to ampicillin, while resistance to ciprofloxacin was common (10.9%). Additionally, we show that nitroxoline is highly active against A. urinae, but not against A. sanguinicola, which based on the presented data, should be considered intrinsically resistant. The presented data will help to improve the therapy of urinary tract infections by Aerococcus species.

Dataset Information

Aerococcus urinae, a cause of cystitis with malodorous urine in a child: clinical and microbiological challenges.

Publications

<i>Aerococcus urinae</i>, a cause of cystitis with malodorous urine in a child: clinical and microbiological challenges.

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