What is the treatment for Aerococcus urinae (A. urinae) bloodstream infection?

From the Research

Treatment for Aerococcus urinae bloodstream infection should involve a 2-week course of penicillin or ampicillin as first-line therapy for uncomplicated bacteremia, and 4-6 weeks for endocarditis or other complicated infections, with consideration of combination therapy with an aminoglycoside like gentamicin for severe cases. The choice of antibiotic should be guided by species identification and antimicrobial susceptibility testing 1. For penicillin-allergic patients, vancomycin or ceftriaxone are appropriate alternatives.

• Key considerations in treatment include:
  • Duration of symptoms: longer than 7 days increases the risk of endocarditis 1
  • Presence of septic emboli: increases the risk of endocarditis 1
  • Use of the DENOVA score: can help identify patients at high risk of endocarditis 1
• Antibiotic regimens should be tailored to the individual patient, taking into account factors such as renal function and allergy history.
• Echocardiography should be performed to rule out endocarditis, particularly in patients with heart valve disease or other risk factors, as A. urinae has a known association with endocarditis and other cardiovascular infections 2, 3, 1.
• The most recent study 1 provides guidance on the management and treatment of Aerococcus bacteremia and endocarditis, and suggests that a 2-week course of treatment for bloodstream infections and a 4-week course for endocarditis can have good outcomes.