Management and treatment of Aerococcus bacteremia and endocarditis

• Published in: International journal of infectious diseases 2021-01, Vol.102, p.584-589
• Main Authors: Tai, Don Bambino Geno, Go, John Raymond, Fida, Madiha, Saleh, Omar Abu
• Format: Article
• Language: English
• Subjects: Adult; Aerococcal bacteremia; Aerococcus; Aerococcus - isolation & purification; Aerococcus urinae; Aerococcus viridans; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacteremia - microbiology; Bloodstream infection; Endocarditis; Endocarditis, Bacterial - diagnosis; Endocarditis, Bacterial - drug therapy; Endocarditis, Bacterial - microbiology; Female; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - microbiology; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Sepsis - diagnosis; Sepsis - drug therapy; Sepsis - microbiology; Young Adult
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.10.096

•Transesophageal echocardiogram should be considered for Aerococcus bloodstream infections with DENOVA score of ≥ 3.•Aerococcal bloodstream infections may be treated successfully with two weeks of intravenous or oral antibiotics based on our experience.•Aerococcus urinae endocarditis may be treated with four weeks of intravenous penicillin or ceftriaxone monotherapy with good outcomes. We describe our multicenter experience on diagnosis and management of Aerococcus bacteremia including the susceptibility profile of Aerococcus species and a suggested algorithm for clinicians. Retrospective study of all patients with positive blood cultures for Aerococcus species from January 2005 to July 2020 in our institution with clinical data and susceptibility profile. Data were collected from both electronic health record and clinical microbiology laboratory database. There were 219 unique isolates with only the susceptibility profiles available, while 81 patients had clinical information available. Forty-nine of those cases were deemed as true bloodstream infection and the rest were of unclear clinical significance. Cases of endocarditis (n = 7) were high-grade, monomicrobial bacteremia caused by Aerococcus urinae. Patients with endocarditis were younger (66 vs 80 p < 0.05). The risk for endocarditis was higher if duration of symptoms was longer than 7 days (OR 105, 95% CI: 5−2271), or if there were septic emboli (OR 71, 95% CI: 3–1612). A DENOVA score cutoff of ≥ 3 was 100% sensitive and 89% specific in detecting endocarditis. The 30-day and 3-month all-cause mortality for bacteremia was 17% and 24%, respectively. Six out of seven patients with endocarditis survived. Antibiotic regimen for aerococcal bloodstream infections and endocarditis should be guided by species identification and antimicrobial susceptibility testing. DENOVA scoring system’s performance in this study is more congruent to other studies. Hence, it can be used as an adjunctive tool in assessing the need for echocardiogram to rule out endocarditis. In our experience, two and four weeks of treatment for bloodstream infections and endocarditis, respectively, had good outcomes.