Treatment considerations for potential uropathogens detected by precision microbiological testing

Am J Health Syst Pharm. 2018 Nov 15;75(22):1775-1782. doi: 10.2146/ajhp180208.


Purpose: The clinical and microbiological data for urinary tract infections (UTIs) for 6 organisms detected by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) at community health systems were examined.

Summary: The use of precision microbiological diagnostic testing such as MALDI-TOF and real-time quantitative polymerase chain reaction has increased the ability to detect a wider spectrum of organisms. This has raised questions of the clinical relevance of infrequently encountered organisms, especially when cultured from urine. This article reviews clinical and microbiological data for UTIs for 6 organisms detected by MALDI-TOF at community health systems (Actinotignum schaalii, Chryseobacterium indologenes, Aerococcus urinae, Aerococcus sanguinicola, Corynebacterium riegelii, and Corynebacterium urealyticum). Since little information currently exists, most of the data associating the aforementioned organisms with UTIs were derived from case reports. Although these organisms are more readily identified using precision microbiological diagnostic testing methods, infection should not be assumed based on culture results alone since asymptomatic bacteriuria has been reported. Similar to more common urinary pathogens, clinical correlation is essential. To facilitate treatment, we provide a table of empirical options likely to achieve clinical success based on in vivo and in vitro data. If available, pathogen-specific susceptibility data should be used to direct therapy.

Conclusion: Clinical and microbiological data and potential treatment options were presented for 6 traditionally underrecognized organisms that are increasingly being found from urinary specimens. The treatment recommendations should be interpreted cautiously as they were devised through the use of very limited data.

Keywords: microbiology; urinary tract infections; urine culture.

Publication types

  • Review

MeSH terms

  • Actinomycetaceae / drug effects
  • Actinomycetales Infections / drug therapy
  • Aerococcus / drug effects
  • Anti-Bacterial Agents / therapeutic use*
  • Chryseobacterium / drug effects
  • Corynebacterium / drug effects
  • Corynebacterium Infections / drug therapy
  • Flavobacteriaceae Infections / drug therapy
  • Gram-Positive Bacterial Infections / drug therapy
  • Humans
  • Microbial Sensitivity Tests
  • Real-Time Polymerase Chain Reaction
  • Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization / methods
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / diet therapy*
  • Urinary Tract Infections / microbiology


  • Anti-Bacterial Agents