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Clinical and microbiological features of infective endocarditis caused by aerococci
Torgny Sunnerhagen1, Bo Nilson2,3, Lars Olaison4,5
1Division of Infection Medicine, Department of Clinical Sciences, Lund University, Tornavägen 10, BMC B14, 221 84, Lund, Sweden.
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.
Insights
Aerococcal infective endocarditis (IE) is most common in older patients with urinary tract issues. Despite comorbidities, the prognosis for aerococcal IE is generally favorable, with limited need for intensive care or fatalities.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Aerococcal infective endocarditis (IE) is a rare but significant condition.
- Understanding its clinical presentation and treatment outcomes is crucial for patient management.
Purpose of the Study:
- To define the clinical presentation of aerococcal IE.
- To determine the prevalence of synergy between penicillin and gentamicin in aerococcal isolates.
Main Methods:
- Retrospective analysis of 16 aerococcal IE cases from the Swedish Registry of Infective Endocarditis (2002-2014).
- Species identification using MALDI-TOF MS.
- Antimicrobial susceptibility testing (Etest, time-kill experiments) for penicillin and gentamicin synergy.
Main Results:
- Sixteen cases confirmed (14 Aerococcus urinae, 2 Aerococcus sanguinicola).
- Penicillin-gentamicin synergy observed in 7 of 15 isolates.
- Patients were older, often with urinary tract disease; 7 presented with severe sepsis, but only 1 required ICU care and no fatalities occurred.
Conclusions:
- This study represents the largest cohort of aerococcal IE.
- Aerococcal IE has a relatively favorable prognosis, even in elderly patients with comorbidities.
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