Division of Infectious Diseases, Department of Medicine, Mayo Clinic, USA.
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, USA.
Int J Infect Dis. 2021 Jan;102:584-589. doi: 10.1016/j.ijid.2020.10.096. Epub 2020 Nov 4.
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.
我们描述了我们在 Aerococcus 菌血症的诊断和治疗方面的多中心经验，包括 Aerococcus 物种的药敏谱和为临床医生提出的算法。
对 2005 年 1 月至 2020 年 7 月期间我院 Aerococcus 物种阳性血培养的所有患者进行回顾性研究，包括临床数据和药敏谱。数据来自电子病历和临床微生物学实验室数据库。
共有 219 株 Aerococcus 细菌分离株，仅提供药敏谱，而 81 例患者有临床资料。其中 49 例被认为是真正的血流感染，其余病例的临床意义不明确。8 例心内膜炎（n=7）为 Aerococcus urinae 引起的高级别、单一微生物菌血症。心内膜炎患者年龄较小（66 岁比 80 岁，p<0.05）。如果症状持续时间超过 7 天（OR 105，95%CI：5-2271）或有败血症栓子（OR 71，95%CI：3-1612），则发生心内膜炎的风险更高。DENOVA 评分≥3 时，检测心内膜炎的敏感性为 100%，特异性为 89%。菌血症的 30 天和 3 个月全因死亡率分别为 17%和 24%。7 例心内膜炎患者中有 6 例存活。
治疗 Aerococcus 菌血症和心内膜炎的抗生素方案应根据菌种鉴定和药敏试验来指导。在本研究中，DENOVA 评分系统的性能与其他研究更为一致。因此，它可以作为评估是否需要超声心动图排除心内膜炎的辅助工具。根据我们的经验，菌血症和心内膜炎的治疗分别为 2 周和 4 周，效果良好。
