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array:24 [ "pii" => "S2254887418300900" "issn" => "22548874" "doi" => "10.1016/j.rceng.2018.04.004" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "1510" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Clin Esp. 2018;218:351-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "PDF" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256518301401" "issn" => "00142565" "doi" => "10.1016/j.rce.2018.04.002" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "1510" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Clin Esp. 2018;218:351-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 51 "formatos" => array:2 [ "HTML" => 33 "PDF" => 18 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Breve</span>" "titulo" => "Infección urinaria por <span class="elsevierStyleItalic">Aerococcus sanguinicola</span>. 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Riera-Mestre, F. Formiga" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Riera-Mestre" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Formiga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256518301887" "doi" => "10.1016/j.rce.2018.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518301887?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301383?idApp=WRCEE" "url" => "/22548874/0000021800000007/v1_201810011013/S2254887418301383/v1_201810011013/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2254887418300936" "issn" => "22548874" "doi" => "10.1016/j.rceng.2018.04.006" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "1517" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2018;218:342-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 1 "PDF" => 3 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Complexity of the medication regimen for polypathological patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "342" "paginaFinal" => "350" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complejidad del régimen de medicación en pacientes pluripatológicos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1384 "Ancho" => 2074 "Tamanyo" => 151695 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Total score and score by section of the Medical Regimen Complexity Index according to the polypathology categories. Section A: galenical form; Section B: administration rate; Section C: additional instructions.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Bellostas-Muñoz, J. Díez-Manglano" "autores" => array:2 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Bellostas-Muñoz" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Díez-Manglano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256518301474" "doi" => "10.1016/j.rce.2018.04.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518301474?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300936?idApp=WRCEE" "url" => "/22548874/0000021800000007/v1_201810011013/S2254887418300936/v1_201810011013/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Original</span>" "titulo" => "Urinary tract infection by <span class="elsevierStyleItalic">Aerococcus sanguinicola</span>. An emerging opportunistic pathogen" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "351" "paginaFinal" => "355" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Jiménez-Guerra, A. Lara-Oya, I. Martínez-Egea, J.M. Navarro-Marí, J. Gutiérrez-Fernández" "autores" => array:5 [ 0 => array:3 [ "nombre" => "G." "apellidos" => "Jiménez-Guerra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Lara-Oya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Martínez-Egea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Navarro-Marí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:4 [ "nombre" => "J." "apellidos" => "Gutiérrez-Fernández" "email" => array:2 [ 0 => "josegf@ugr.es" 1 => "josegf@go.ugr.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Laboratorio de Microbiología, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Microbiología, Facultad de Medicina, Universidad de Granada-Instituto de Investigación Biosanitaria, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección urinaria por <span class="elsevierStyleItalic">Aerococcus sanguinicola</span>. Patógeno emergente oportunista" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 853 "Ancho" => 1733 "Tamanyo" => 203341 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Urine sample seeded in Uriselect 4 (a) and isolation of colony in blood agar plate (b).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Aerococcus</span> genus was first described in 1953 by Williams<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> (the first reported species of which was <span class="elsevierStyleItalic">Aerococcus viridans</span>) as Gram-positive, facultative anaerobic, catalase-negative, alpha-hemolytic, mainly colony-forming cocci that can grow in the presence of 6.5% NaCl. In subsequent years, cases of infections in humans caused by <span class="elsevierStyleItalic">Aerococcus</span>-like organisms were published, resulting in the description of the new species. The genus includes 7 distinct species, 5 of which are known to be human pathogens: <span class="elsevierStyleItalic">A. christensenii</span>, <span class="elsevierStyleItalic">A. sanguinicola</span>, <span class="elsevierStyleItalic">A. urinae</span>, <span class="elsevierStyleItalic">A. urinaehominis</span> and <span class="elsevierStyleItalic">A. viridans</span>.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A. christensenii</span> has been isolated in vaginal samples and is an agent that causes endocarditis, bacteremia and chorioamnionitis. <span class="elsevierStyleItalic">A. sanguinicola</span> has been isolated in blood samples and produces endocarditis. <span class="elsevierStyleItalic">A. urinae</span> is an emerging human pathogen that can cause diseases such as urinary tract infection (UTI),<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2–4</span></a> endocarditis, bacteremia, spondylodiscitis and obstetric wound infections.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5–8</span></a><span class="elsevierStyleItalic">A. urinaehominis</span> has been isolated only in urine samples as an agent causing urinary tract infections. Lastly, on rare occasions, <span class="elsevierStyleItalic">A. viridans</span> causes infections in humans but has been reported in cases of meningitis, endocarditis, bacteremia, UTIs, spondylodiscitis, wound infection, odontogenic infection and paraaortic abscess.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Species identification had always been difficult until the arrival of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry, because the commercial phenotypic methods offered only the identification of the <span class="elsevierStyleItalic">A. viridans</span> species<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a> or were confused with other species belonging to <span class="elsevierStyleItalic">Gemella</span> spp. or <span class="elsevierStyleItalic">Leuconostoc</span> spp.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">2,10,11</span></a> At first glance, the alpha-hemolytic colonies of <span class="elsevierStyleItalic">Aerococcus</span> spp. are often mistaken for colonies of streptococci of the <span class="elsevierStyleItalic">viridans</span> or <span class="elsevierStyleItalic">Lactobacillus</span> spp. group.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> Their presence in urine cultures has therefore long gone unnoticed due to being mistaken for part of the regional microbiota.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> There has therefore been an increase in the diagnosis of this pathogen as the etiology of infectious processes due to the implementation of MALDI-TOF mass spectrometry.</p><p id="par0020" class="elsevierStylePara elsevierViewall">During 2017, our laboratory detected 2 cases of UTI due to <span class="elsevierStyleItalic">A. sanguinicola</span> in elderly patients with underlying urological disease, which we will discuss below.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A descriptive clinical-microbiological study was conducted on the presence of <span class="elsevierStyleItalic">A. sanguinicola</span> as the causal agent of UTIs. When performing diagnoses, our microbiology laboratory (located in Hospital Virgen de la Nieves of Granada) processes urine samples from patients treated only in the hospital complex. These samples were collected and processed in culture media according to a previously described procedure.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> During 2017, growing green colonies were identified in Uriselect4, with a significant count, using mass spectrometry (MALDI Biotyper, Bruker Daltonics, Billerica, US) when not identified as enterococci. Antibiograms of these isolated strains were performed using Etest strips (Liofilchem, Roseto degli Abruzzi, Italy) in Mueller–Hinton agar with 5% sheep blood, incubated for 18<span class="elsevierStyleHsp" style=""></span>h at 37<span class="elsevierStyleHsp" style=""></span>°C in a CO<span class="elsevierStyleInf">2</span> atmosphere, and the minimum inhibitory concentrations (MICs) obtained were interpreted according to 2016 Clinical and Laboratory Standards Institute (CLSI) criteria.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results. Case description</span><p id="par0030" class="elsevierStylePara elsevierViewall">During 2017, we isolated 1453 microorganisms in examined urine cultures. These microorganisms included enterobacteria (46%), enterococci (24%), yeasts (18%), Gram-negative nonglucose-fermenting bacilli (7%), streptococci (2%), staphylococci (1%) and other bacteria (2%). These included 2 clinical isolates of <span class="elsevierStyleItalic">A. sanguinicola</span> in urine samples from patients described below.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patient 1</span><p id="par0035" class="elsevierStylePara elsevierViewall">The 80-year-old patient, dependent for basic activities of daily life, was admitted to the emergency department due to a progressive increase in cognitive impairment over the previous week, as well as anorexia, a feeling of dysthermia and reduced diuresis. The urine had a purulent appearance. The patient's history of interest included benign prostatic hypertrophy, pheochromocytoma (which was operated on in 2005) complicated with severe acute pancreatitis, dementia, 2 episodes of acute pulmonary thromboembolism (2009 and 2012) and hip fractures 10 years earlier. During his stay at the observation unit, the patient presented malaise, a tendency toward hypotension, poor distal infusion of the limbs and oligoanuria. The patient was aware, disoriented and had mucocutaneous pallor. His blood pressure was 88/56<span class="elsevierStyleHsp" style=""></span>mmHg, and his oxygen saturation was 98%. The fever was measured with a thermometer at 37.4<span class="elsevierStyleHsp" style=""></span>°C. After stabilizing the patient clinically and hemodynamically, provisional catheterization was inserted, and antibiotic treatment was started with oral levofloxacin at 500<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h and 2<span class="elsevierStyleHsp" style=""></span>g of intravenous ceftriaxone. The patient was admitted to the internal medicine unit with a diagnosis of septic shock of urinary origin associated with renal failure. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main clinical data. The laboratory tests revealed increased acute-phase reactants (C-reactive protein level of 287<span class="elsevierStyleHsp" style=""></span>mg/L and a procalcitonin level of 66.01<span class="elsevierStyleHsp" style=""></span>ng/mL). The urinalysis analysis showed 360.88<span class="elsevierStyleHsp" style=""></span>cells/μL and 469.30<span class="elsevierStyleHsp" style=""></span>red<span class="elsevierStyleHsp" style=""></span>blood<span class="elsevierStyleHsp" style=""></span>cells/μL, proteinuria of 150<span class="elsevierStyleHsp" style=""></span>mg/dL and a pH of 8. Upon admission to the internal medicine ward, the antibiotic treatment was replaced with oral amoxicillin/clavulanic acid (875/125<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>h). We seeded the urine culture sent to our laboratory in a chromogenic medium and incubated it in an aerobic atmosphere at 37<span class="elsevierStyleHsp" style=""></span>°C for 18<span class="elsevierStyleHsp" style=""></span>h. We observed bacterial growth with a count >10,000<span class="elsevierStyleHsp" style=""></span>colony-forming<span class="elsevierStyleHsp" style=""></span>units/mL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and only small blue colonies, which, in the Gram staining performed to identify the colonies, were observed as grouped Gram-positive cocci. The identification was performed using MALDI-TOF, obtaining a score of 2107 for the <span class="elsevierStyleItalic">A. sanguinicola</span> result. The antibiotic sensitivity study showed that the microorganism was resistant to ciprofloxacin and sensitive to cefotaxime, meropenem, penicillin and vancomycin. After 48<span class="elsevierStyleHsp" style=""></span>h of hospitalization with the prescribed antibiotic treatment, the patient progressed favorably, becoming afebrile, and showing a good diuresis rhythm and an acceptable general condition. The patient was discharged with outpatient antibiotic treatment (amoxicillin–clavulanic acid 875/125<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>h) for 5 more days.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Patient 2</span><p id="par0040" class="elsevierStylePara elsevierViewall">An 88-year-old man was admitted to the emergency department due to sudden-onset urinary retention. The patient's history included kidney stones, arterial hypertension and glaucoma. In this episode, the patient complained of suprapubic pain with intermittent hematuria, with no feelings of dysthermia. The physical examination only revealed the presence of a bladder balloon. The patient underwent bladder catheterization and a systematic and microbiological urine analysis. Treatment was prescribed with cefuroxime at 500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h for 5 days, and the patient was admitted to the care of the internal medicine department. After the patient clinically improved after 5 days of hospitalization, he was discharge to his home with silodosin at 8<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h for 1 month. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main clinical data. The urine culture was performed in the same conditions as in the previous case, achieving a count >10,000<span class="elsevierStyleHsp" style=""></span>colony-forming units/mL of a small colony in single culture, which was blue and was identified as <span class="elsevierStyleItalic">A. sanguinicola</span> using MALDI-TOF, with a score of 2099. The antibiotic sensitivity study showed that the microorganism was resistant to ciprofloxacin and sensitive to cefotaxime, meropenem, penicillin, tetracycline and vancomycin.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In both cases, the species identification was subsequently confirmed through ARNr 16S sequencing.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Problems have been reported in identifying the various species of the <span class="elsevierStyleItalic">Aerococcus</span> genus using biochemical tests, mistaking these for species from the same genus or with <span class="elsevierStyleItalic">Gemella</span> spp.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">14,15</span></a> The sequencing of gene ARNr 16S is the gold standard method for identification.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">11,16</span></a> To our understanding, mass spectrometry technology is therefore an alternative for identifying the most relevant species. This approach has led to considering <span class="elsevierStyleItalic">Aerococcus</span> as a possible emerging pathogen, given that it is highly likely that its prevalence is underestimated. There are studies that have placed the incidence rate of <span class="elsevierStyleItalic">Aerococcus</span> spp. in urine cultures between 0.2% and 0.8%, and in these cases, the presence of urinary symptoms occurs between 55% and 98%.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">3,6,17,18</span></a> The studies do not concur as to which sex has a greater prevalence of bacteriuria by <span class="elsevierStyleItalic">Aerococcus</span> spp.; however, they do report that this condition occurs in elderly patients (as occurred in the 2 cases we presented earlier), frequently with urovesical disease or catheterization or with neurological deficits such as dementia or trisomy 21.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">3,5,6,17,18</span></a> Classical studies have indicated that diabetes mellitus and neuropathy are other risk factors for UTI caused by <span class="elsevierStyleItalic">Aerococcus</span>-like pathogens, such as <span class="elsevierStyleItalic">Aerococcus</span> spp., <span class="elsevierStyleItalic">Gemella</span> spp., <span class="elsevierStyleItalic">Granulicatella</span> spp. and <span class="elsevierStyleItalic">Pediococcus</span> spp.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a> In the 2 patients in this study, we found underlying urological disease, such as kidney stones and benign prostatic hyperplasia, which impede the flow of urine. In the first case, we also found a patient with a certain neurological deficit.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A. sanguinicola</span> could be the second bacteria of the genus most often isolated in urine cultures, after <span class="elsevierStyleItalic">A. urinae</span>. Since the inclusion of <span class="elsevierStyleItalic">A. sanguinicola</span> as a species in 2001,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> the infectious disease it causes has been seldom studied, with cases of bacteremia being reported but with very little information on whether it can cause other type of infections. When bacteremia is caused by <span class="elsevierStyleItalic">Aerococcus</span> spp., the focus is suspected to be in the urinary tract.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> A number of studies have discussed virulence factors, such as the pathogen's ability to form biofilms, which is important for patients with urinary catheters or other devices, and its capacity to aggregate platelets.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a> Based on our experience, chromogenic media are useful for recovering the pathogen in urine cultures and do not require, in principle, a selective culture medium for Gram-positive bacteria in urine.</p><p id="par0060" class="elsevierStylePara elsevierViewall">There are no studies on the recommendations for the antibiotic treatment of <span class="elsevierStyleItalic">A. sanguinicola</span>, but the genus <span class="elsevierStyleItalic">Aerococcus</span> is fairly sensitive to beta-lactams and vancomycin. The 2016 CLSI report introduced, for the first time, cutoffs for determining the antibiotic sensitivity of <span class="elsevierStyleItalic">Aerococcus</span> spp., both by microdilution and by disc diffusion. In this genus, more than 90% of isolates have sensitivity to ampicillin and benzylpenicillins.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> Penicillins are therefore the most frequent treatment selection for clinicians, replacing the penicillins with vancomycin for patients who are allergic. The MICs for meropenem and imipenem are low, with some exceptions.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> Low-level resistance to aminoglycosides have been encountered, although these can be used in the treatment due to their ability to produce synergy when used with beta-lactams, although this does not always occur.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleItalic">A. sanguinicola</span> presents high MICs both for fluoroquinolones<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> and for fosfomycin<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> and trimethoprim.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> There are studies that recommend treating uncomplicated UTI caused by this microorganism with nitrofurantoin.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0065" class="elsevierStylePara elsevierViewall">When there is a significant number of alpha-hemolytic microorganisms in the urine cultures, we should rule out pathogenic bacteria of the <span class="elsevierStyleItalic">Aerococcus</span> genus.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1087497" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1031477" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1087498" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1031478" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results. Case description" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient 1" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Patient 2" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-21" "fechaAceptado" => "2018-04-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1031477" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Aerococcus sanguinicola</span>" 1 => "Urinary tract infection" 2 => "Mass spectrometry" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1031478" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Aerococcus sanguinicola</span>" 1 => "Infección del tracto urinario" 2 => "Espectrometría de masas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Elderly patients with underlying urological disease have a greater risk of urinary tract infections due to uncommon pathogens. The disease caused by <span class="elsevierStyleItalic">Aerococcus</span> has been underestimated, but mass spectrometry could be a simple method for identifying this pathogen. In this study, we report 2 cases of urinary tract infection by <span class="elsevierStyleItalic">Aerococcus sanguinicola.</span> A descriptive clinical-microbiological study was conducted on the presence of <span class="elsevierStyleItalic">A. sanguinicola</span> causing urinary tract infections. The presence of <span class="elsevierStyleItalic">A. sanguinicola</span> occurred in elderly patients with previous urological disease and a significant count in urine obtained through bladder catheterization. Correct identification was achieved through mass spectrometry, and the clinical outcome of administering amoxicillin and cefuroxime was satisfactory. In this study, we also report the pathogenic capacity of <span class="elsevierStyleItalic">A. sanguinicola</span>. When there is a significant number of alpha-hemolytic microorganisms in the urine cultures, <span class="elsevierStyleItalic">A. sanguinicola</span> should be ruled out before reporting a result as urogenital microbiota.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los pacientes ancianos con enfermedad urológica de base tienen mayor riesgo de infecciones del trato urinario por patógenos infrecuentes. Previamente se ha infraestimado la enfermedad causada por <span class="elsevierStyleItalic">Aerococcus</span>, pero la espectrometría de masas podría ser un método sencillo para su identificación. En este trabajo se describen 2 casos de infección urinaria por <span class="elsevierStyleItalic">Aerococcus sanguinicola (A. sanguinicola).</span> Se realizó un estudio descriptivo clínico-microbiológico de la presencia de <span class="elsevierStyleItalic">A. sanguinicola</span> produciendo infecciones urinarias. La presencia de <span class="elsevierStyleItalic">A. sanguinicola</span> ocurrió en pacientes ancianos con enfermedad urológica previa y con un recuento significativo en orinas obtenidas mediante sondaje vesical. La identificación fue correcta mediante espectrometría de masas. La evolución clínica fue satisfactoria mediante el uso de amoxicilina y cefuroxima. En este trabajo informamos de la capacidad patógena de <span class="elsevierStyleItalic">A. sanguinicola</span>. En el urocultivo, ante un recuento significativo de microorganismos alfa-hemolíticos, deberíamos descartar que se trate de <span class="elsevierStyleItalic">A. sanguinicola</span> antes de informar un resultado como microbiota urogenital.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez-Guerra G, Lara-Oya A, Martínez-Egea I, Navarro-Marí JM, Gutiérrez-Fernández J. Infección urinaria por <span class="elsevierStyleItalic">Aerococcus sanguinicola</span>. Patógeno emergente oportunista. Rev Clin Esp. 2018;218:351–355.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 853 "Ancho" => 1733 "Tamanyo" => 203341 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Urine sample seeded in Uriselect 4 (a) and isolation of colony in blood agar plate (b).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urological disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benign prostatic hypertrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kidney stones \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dementia, pheochromocytoma, TEP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypertension, glaucoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clinical symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fever, hypotension, oligoanuria, disorientation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Urinary retention, suprapubic pain \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MALDI-TOF score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2099 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antibiotic treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Amoxicillin–clavulanic acid 875/125<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>h, 7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cefuroxime 500<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h, 5 days \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1858319.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical data on the cases of urinary tract infection by <span class="elsevierStyleItalic">A. sanguinicola</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Aerococcus</span>, a new bacterial genus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.E. 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