Table 2.
Demographics with details of urine, blood culture, antibiotics given with days, and hospital course
| Case | Age | Urine culture | Blood culture results | Likely source for Aerococcus bacteremia | TTE/TEE | Antibiotic regimen | Days of antibiotics | Hospital course, assessment, and management |
|---|---|---|---|---|---|---|---|---|
| 1 | 99 | No growth |
A. viridans
Coagulase-negative S. aureus |
Contaminant | No vegetation | Vancomycin, ceftazidime, metronidazole | 10 | Had exploratory laparotomy and right-sided incarcerated hernia repair 3 days before admission, postoperative period complicated by hypoxemia, hypotension followed by intubation and vasopressor support Positive modified barium study for aspiration requiring PEG tube Aerococcus was considered as a contaminant infection |
| 2 | 84 |
Aerococcus, unspecified E. faecalis |
A. urinae | UTI | No vegetation | Ampicillin | 14 | Developed sepsis requiring pressure support, developed rapid ventricular rate transiently requiring dose increment of metoprolol |
| 3 | 81 | P. aeruginosa | A. urinae E. faecalis | Pacemaker lead endocarditis, UTI | AV vegetation, right atrial pacer lead vegetation | Vancomycin | 10 | Developed worsening sepsis despite being on antibiotics, he was planned for removal of infected pacemaker but deteriorated and expired |
| 4 | 55 | No growth |
A. urinae
E. faecalis (Group D) |
UTI, renal stones | No vegetation | Piperacillin and tazobactam | 10 | CT showed large hematoma formation within the bladder, no hydroureteronephrosis, multiple small stones in both kidneys He underwent bladder irrigation with one unit of blood transfusion |
| 5 | 87 | Aerococcus, unspecified | A. urinae | UTI | Not done | Vancomycin, piperacillin, and tazobactam f/b amoxicillin | 5 | Had hypotension initially, required pressure support and ICU care Two-unit PRBCs for anemia |
| 6 | 81 | P. aeruginosa | A. viridans | Contaminant | Not done | Piperacillin and tazobactam | 1 | A patient came with massive gastrointestinal bleed Her repeat urine culture grew P. aeruginosa Had hemorrhagic shock possibly due to acute mesenteric syndrome and died within 6 h of arrival |
| 7 | 87 | A. viridans | A. viridans | Unknown | Normal | Vancomycin, piperacillin and tazobactam | 1 | Developed septic shock with hypoxic respiratory failure Family opted for hospice care |
| 8 | 72 | Streptococcus (1000-10,000 col/ml) | A. urinae | Instrumentation-related UTI | Not done | Ertapenem | 14 | Postlithotripsy and right ureteral stent, he developed fever, hypotension Found to have Aerococcus bacteremia |
| 9 | 72 | No growth | A. urinae | Cystitis | No vegetation | Vancomycin f/b amoxicillin | 10 | CT abdomen showed evidence of nonobstructive hydroureteronephrosis with bladder wall thickening |
| 10 | 90 | Mixed Gram-positive growth (10,000-50,000 col/ml) |
A. viridans
P. mirabilis |
Complicated UTI, right urolithiasis, hydroureteronephrosis | Not done | Ceftriaxone f/b sulfamethoxazole and trimethoprim | 14 | CT abdomen showed right urolithiasis with hydroureteronephrosis. She underwent cystoscopy and stent placement for decompression of ureteral system, improved with antibiotics |
| 11 | 49 | Mixed Gram-positive organisms (>100,000 col/ml) |
A. urinae
A. baumannii Coagulase-negative S. aureus |
Contaminant | Not done | Ceftriaxone, IV | 5 | A patient came for abdominal pain, CT showed evidence of colitis and Acinetobacter-related bacteremia |
| 12 | 62 | No growth | A. viridans | Contaminant | Not done | Vancomycin and ceftazidime, IV | 10 | Was treated for aspiration pneumonia and HCAP as he was a nursing home resident |
| 13 | 80 | Aerococcus, unspecified (>100,000 col/ml) | A. urinae | IV drug abuse (bloodstream infection) leading IE, UTI | Mass (0.5 cm × 0.5 cm) on mitral anterior leaflet | Vancomycin, IV | 14 | Presented with right middle cerebral infarct, toxicology was found positive for cocaine abuse, mitral valve vegetations Both urine and blood culture grew A. urinae, a patient had a significant neurological deficit, underwent PEG tube placement, and discharged to rehabilitation services |
| 14 | 87 | Mixed Gram-positive growth (10,000-50,000 col/ml) | A. urinae | Unknown | No vegetation | Vancomycin, IV | 42 | Found to have right frontal stroke, TTE-normal Vancomycin×6 weeks planned for presumed IE, discharged to rehabilitation services |
| 15 | 64 | Alpha-hemolytic Streptococcus |
Aerococcus, unspecified Diphtheroids |
Contaminant | Not done | Levofloxacin, IV | 10 | Fever and dysuria at presentation, was treated with levofloxacin |
| 16 | 51 | Not sampled | A. viridans | Contaminant | Not done | Vancomycin, PO | 14 | Fever and diarrhea were worked up and found to have C. difficile-related diarrhea |
| 17 | 78 | No growth | A. urinae | Penile cellulitis, bilateral pyelonephritis | Not done | Vancomycin, IV | 14 | Was septic at presentation, likely source penile cellulitis, pyelonephritis |
| 18 | 68 | No growth | Aerococcus, unspecified | Unknown | Not done | Vancomycin f/b ceftriaxone, IV | 14 | A patient came for altered sensorium which responded to antibiotics and supportive management |
| 19 | 72 | Not sampled | Aerococcus, unspecified | IE | AV vegetation | Ceftriaxone, IV | 42 | TEE confirmed AV endocarditis, treated with 6 weeks of ceftriaxone |
| 20 | 74 | Lactobacillus |
Aerococcus, unspecified Coagulase-negative S. aureus |
Contaminant | Not done | None | 0 | A patient had decubitus ulcer for which he underwent local debridement |
A. viridans: Aerococcus viridans, S. aureus: Staphylococcus aureus, E. faecalis: Enterococcus faecalis, A. urinae: Aerococcus urinae, UTI: Urinary tract infection, P. aeruginosa: Pseudomonas aeruginosa, CT: Computed tomography, P. mirabilis: Proteus mirabilis, A. baumannii: Acinetobacter baumannii, IV: Intravenous, C. difficile: Clostridium difficile, AV: Aortic valve, PO: per oral, TTE: Transthoracic echocardiogram, TEE: Transesophageal echo, PEG: Percutaneous endoscopic gastrostomy, PRBCs: Packed red blood cells, IE: Infective endocarditis, HCAP: Health care associated pneumonia, f/b: Followed by