From the Guidelines
Aerococcus urinae infective endocarditis should be treated with a prolonged course of intravenous antibiotics, typically a combination of penicillin G or ampicillin plus gentamicin for 4-6 weeks, with surgical intervention considered in cases with severe valve destruction or embolic risk. The diagnosis of Aerococcus urinae infective endocarditis is often challenging due to its rare and variable presentation, but it is essential to consider this condition in patients with fever, embolic phenomena, or heart murmurs, as emphasized in the 2015 ESC guidelines for the management of infective endocarditis 1. Blood cultures should be obtained before starting antibiotics to confirm the diagnosis and determine antibiotic susceptibility. Transesophageal echocardiography is crucial for diagnosis and assessing valve damage, as highlighted in the 2015 ESC guidelines 1.
Some key points to consider in the management of Aerococcus urinae infective endocarditis include:
- The importance of addressing underlying urological issues to prevent recurrence, as the bacterium typically enters the bloodstream from the urinary tract
- The need for close monitoring for complications, including heart failure, embolic events, and antibiotic side effects
- The consideration of surgical intervention in cases with severe valve destruction, persistent infection despite appropriate antibiotics, or large vegetations with embolic risk
- The significance of prompt diagnosis and aggressive management, given the high mortality rates associated with this condition, approximately 20-25% as noted in general infective endocarditis management 1.
It is also important to note that the care of patients with infective endocarditis, including those with Aerococcus urinae, is best provided by specialized centers with expertise in cardiology, infectious diseases, and cardiac surgery, as emphasized in the 2015 ESC guidelines 1 and the 2015 AHA scientific statement 1.
From the Research
Aerococcus urinae Infective Endocarditis
- Aerococcus urinae is a gram-positive coccus bacterium that can cause infective endocarditis, with reports of cases increasing due to advancements in diagnostic technologies such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) 2.
- The bacterium is often associated with urinary tract infections, but can also cause serious complications like endocarditis and septicemia, with a high mortality rate and risk of severe neurological problems 3.
- Aerococcus urinae has been found to be a potent biofilm builder in endocarditis, with fluorescence in situ hybridization (FISH) used to visualize and identify the microorganism in heart valve tissue 4.
Clinical Presentation and Management
- Patients with Aerococcus urinae infective endocarditis often present with fever, heart murmur, and embolic events, and may have a history of urinary tract infections 2, 5.
- The diagnosis of Aerococcus urinae infective endocarditis can be challenging, with blood cultures often being negative, and the use of broad-range PCR and direct sequencing of the 16S rRNA gene may be necessary to identify the causative agent 3.
- Treatment of Aerococcus urinae infective endocarditis typically involves antibiotic therapy, with a suggested duration of 4-6 weeks, and may require valve replacement surgery in severe cases 2, 6, 5.
- The DENOVA scoring system can be used as an adjunctive tool to assess the need for echocardiogram to rule out endocarditis, with a cutoff of ≥ 3 being 100% sensitive and 89% specific in detecting endocarditis 6.
Antibiotic Susceptibility and Resistance
- Aerococcus urinae has been found to be resistant to sulfonamides, and antibiotic therapy should be guided by species identification and antimicrobial susceptibility testing 3, 6.
- The use of penicillin G and gentamicin has been reported in the treatment of Aerococcus urinae infective endocarditis, but the optimal antibiotic regimen is not well established 5.