SHM Converge Scientific Abstract ePoster Gallery-Invasive Aortic Valve Infective Endocarditis From Aerococcus Urinae Bacteremia

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This document summarizes rare but serious invasive infection caused by <strong>Aerococcus urinae</strong>, a gram-positive coccus increasingly linked to <strong>biofilm formation, bacteremia, and infective endocarditis (IE)</strong>. The text cites recent literature showing that A. urinae can be a potent biofilm builder and can cause destructive aortic valve disease.

A major case described is a <strong>58-year-old man</strong> with a history of <strong>urethral stricture treated with dilation</strong>, a known risk factor for Aerococcus colonization after urethral instrumentation. He presented with <strong>progressive shortness of breath, cough, fever, and presumed pneumonia</strong>, and was started on levofloxacin. His condition rapidly worsened in the ICU, progressing to <strong>ARDS, shock, and worsening kidney function</strong>. Initial blood cultures were slow to speciate, eventually identifying <strong>A. urinae at 72 hours</strong>.

Because the patient had persistent hypotension, wide pulse pressure, and gram-positive cocci bacteremia, <strong>infective endocarditis</strong> became a concern. A <strong>transthoracic echocardiogram (TTE)</strong> showed no vegetations, but <strong>transesophageal echocardiography (TEE)</strong> revealed a <strong>2 x 0.9 cm vegetation on the aortic valve</strong>, <strong>perforation of the cusps</strong>, a <strong>small aortic root abscess</strong>, and <strong>eccentric aortic regurgitation</strong>. This highlights that <strong>TEE is more sensitive than TTE</strong> for detecting aortic valve vegetations.

The discussion notes that <strong>risk factors for Aerococcus bacteremia</strong> include <strong>older age, male sex, and pre-existing urinary tract pathology</strong>, especially prior urethral instrumentation. Most isolates are susceptible to <strong>penicillins, aminoglycosides, and fluoroquinolones</strong>, but delayed identification can allow rapid deterioration into severe sepsis or cardiogenic shock. The case underscores the need for <strong>early suspicion, prompt echocardiographic evaluation, and rapid treatment</strong> when alpha-hemolytic gram-positive cocci bacteremia is accompanied by shock.

Asset Subtitle

Deeksha N. Acharya

Meta Tag

Author List Chelcie Costabile, Deeksha N. Acharya, Sourabh Khatri

Category Clinical Vignettes

Concept Aerococcus urinae

Concept Infective Endocarditis

Concept Bacteremia

Concept Vegetation

Concept Sepsis

Distinguished Non-Finalist

Presenter Organization UPMC McKeesport Internal Medicine Program

Presenting Author Deeksha N. Acharya

Track Adult

Keywords

Aerococcus urinae

biofilm formation

bacteremia

infective endocarditis

aortic valve vegetation

transesophageal echocardiography

urethral stricture

urinary tract pathology

gram-positive cocci

septic shock

Aerococcus urinae

Infective Endocarditis

Bacteremia

Vegetation

Sepsis