S. aureus

Emery Haley, PhD, Scientific Writing Specialist

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Clinical Summary

C. koseri is recognized as a classical gram-negative, urease-variable, biofilm-forming uropathogen. 
C. koseri is associated with complicated UTI in older adult and pediatric populations. 
In symptomatic UTI patients, C. koseri: 
- Is not a contaminant (is found in catheter-collected urine specimens). 
- Is viable (can grow out on culture). 
- Is pathogenic (associated with elevated urine biomarkers of infection). 
Reported severe complications of C. koseri UTI include pyelonephritis, polymicrobial bacteremia, and urosepsis. 
Multidrug-resistant C. koseri (especially among hospital-acquired UTIs) is a significant global health threat.

Bacterial Characteristics

Gram-stain

Gram-negative

Morphology

Bacillus

Growth Requirements

Non-fastidious (grows well in standard urine culture conditions)
Facultative anaerobe

Nitrate Reduction

Yes

Urease

Variable

Biofilm Formation

Yes

Pathogenicity

Colonizer or Pathobiont

Clinical Relevance in UTI

C. koseri is a urease-variable microorganism [1] capable of forming biofilms. C. koseri is typically considered to be among the common classical uropathogens in older adults,[2]  but is also being increasingly recognized as common in pediatric UTIs.[3]

In a study of older adult males and females with clinically suspected complicated UTI, C. koseri was detected in both midstream voided and in-and-out-catheter collected specimens indicating that it was truly present in the bladder, not simply a contaminant picked up during voiding.[4]  Furthermore, elevated markers of immune system activation in the urinary tract have been measured from the same clinical urine specimens in which C. koseri was detected, indicating that the presence of C. koseri was associated with an immune response to urinary tract infection.[5–7]   Hospital-acquired C. koseri UTIs pose a particularly serious threat, as these infections increasingly display multidrug- or pandrug-resistance.[8]  Severe complications of C. koseri UTI, including pyelonephritis, polymicrobial bacteremia, and urosepsis, have been reported.[9–11]

Hospital-acquired C. koseri UTIs pose a particularly serious threat, as these infections increasingly display multidrug- or pandrug-resistance.[8]  Although not considered one of the six highest priority “ESKAPE” pathogens, The World Health Organization (WHO) has included this organism in the 2024 Bacterial Priority Pathogens List (BPPL).[111] Severe complications of C. koseri UTI, including pyelonephritis, polymicrobial bacteremia, and urosepsis, have been reported.[9–11] 

Together, these findings indicate that C. koseri should be seriously considered as a uropathogen and demonstrate the value of detecting this organism, particularly in individuals with recurrent UTI and/or risk factors for persistent or complicated UTI.

Treatment

Evidence of Efficacy (Checkmarks): Amoxicillin/Clavulanate, Ampicillin/Sulbactam, Cefaclor, Cefazolin, Cefepime, Cephalexin, Ceftazidime, Ceftriaxone, Ciprofloxacin, Gentamicin, Levofloxacin, Meropenem, Nitrofurantoin, Piperacillin/Tazobactam, Sulfamethoxazole/Trimethoprim, and Trimethoprim.

References

1. BacDive | The Bacterial Diversity Metadatabase Available online: https://bacdive.dsmz.de/ (accessed on 11 February 2025).
2. Moreland, R.B.; Brubaker, L.; Tinawi, L.; Wolfe, A.J. Rapid and Accurate Testing for Urinary Tract Infection: New Clothes for the Emperor. Clin. Microbiol. Rev. 2024, e0012924, doi:10.1128/cmr.00129-24.
3. Brubaker, L.; Chai, T.C.; Horsley, H.; Khasriya, R.; Moreland, R.B.; Wolfe, A.J. Tarnished Gold—the “Standard” Urine Culture: Reassessing the Characteristics of a Criterion Standard for Detecting Urinary Microbes. Front. Urol. 2023, 3, 1206046, doi:10.3389/fruro.2023.1206046.
4. Saenkham-Huntsinger, P.; Hyre, A.N.; Hanson, B.S.; Donati, G.L.; Adams, L.G.; Ryan, C.; Londoño, A.; Moustafa, A.M.; Planet, P.J.; Subashchandrabose, S. Copper Resistance Promotes Fitness of Methicillin-Resistant Staphylococcus Aureus during Urinary Tract Infection. mBio 2021, 12, 10.1128/mbio.02038-21, doi:10.1128/mbio.02038-21.
5. Muder, R.R.; Brennen, C.; Rihs, J.D.; Wagener, M.M.; Obman, A.; Stout, J.E.; Yu, V.L. Isolation of Staphylococcus Aureus from the Urinary Tract: Association of Isolation with Symptomatic Urinary Tract Infection and Subsequent Staphylococcal Bacteremia. Clin Infect Dis 2006, 42, 46–50, doi:10.1086/498518.
6. Zubair, K.U.; Shah, A.H.; Fawwad, A.; Sabir, R.; Butt, A. Frequency of Urinary Tract Infection and Antibiotic Sensitivity of Uropathogens in Patients with Diabetes. Pak. J. Méd. Sci. 2019, 35, 1664–1668, doi:10.12669/pjms.35.6.115.
7. Wang, D.; Haley, E.; Luke, N.; Mathur, M.; Festa, R.; Zhao, X.; Anderson, L.A.; Allison, J.L.; Stebbins, K.L.; Diaz, M.J.; et al. Emerging and Fastidious Uropathogens Were Detected by M-PCR with Similar Prevalence and Cell Density in Catheter and Midstream Voided Urine Indicating the Importance of These Microbes in Causing UTIs. Infect. Drug Resist. 2023, Volume 16, 7775–7795, doi:10.2147/idr.s429990.
8. Haley, E.; Luke, N.; Mathur, M.; Festa, R.A.; Wang, J.; Jiang, Y.; Anderson, L.A.; Baunoch, D. The Prevalence and Association of Different Uropathogens Detected by M-PCR with Infection-Associated Urine Biomarkers in Urinary Tract Infections. Res. Rep. Urol. 2024, 16, 19–29, doi:10.2147/rru.s443361.
9. Selim, S.; Faried, O.A.; Almuhayawi, M.S.; Saleh, F.M.; Sharaf, M.; Nahhas, N.E.; Warrad, M. Incidence of Vancomycin-Resistant Staphylococcus Aureus Strains among Patients with Urinary Tract Infections. Antibiotics 2022, 11, 408, doi:10.3390/antibiotics11030408.
10. Xu, K.; Wang, Y.; Jian, Y.; Chen, T.; Liu, Q.; Wang, H.; Li, M.; He, L. Staphylococcus Aureus ST1 Promotes Persistent Urinary Tract Infection by Highly Expressing the Urease. Front. Microbiol. 2023, 14, 1101754, doi:10.3389/fmicb.2023.1101754.
11. Yoo, J.-J.; Shin, H.B.; Song, J.S.; Kim, M.; Yun, J.; Kim, Z.; Lee, Y.M.; Lee, S.W.; Lee, K.W.; Kim, W.B.; et al. Urinary Microbiome Characteristics in Female Patients with Acute Uncomplicated Cystitis and Recurrent Cystitis. J. Clin. Med. 2021, 10, 1097, doi:10.3390/jcm10051097.
12. Hochstedler, B.R.; Burnett, L.; Price, T.K.; Jung, C.; Wolfe, A.J.; Brubaker, L. Urinary Microbiota of Women with Recurrent Urinary Tract Infection: Collection      and Culture Methods. Int Urogynecol J 2022, 33, 563–570, doi:10.1007/s00192-021-04780-4.
13. Mason, C.Y.; Sobti, A.; Goodman, A.L. Staphylococcus Aureus Bacteriuria: Implications and Management. JAC-Antimicrob. Resist. 2023, 5, dlac123, doi:10.1093/jacamr/dlac123.
14. Thorn, D.J.; Wolfe, V.; Inder, P.; Lin, V.W.-H. Methicillin-Resistant Staphylococcus Aureus in Patients with Spinal Cord Injury. J. Spinal Cord Med. 1999, 22, 125–131, doi:10.1080/10790268.1999.11719558.
15. Carvalho, F.M.; Mergulhão, F.J.M.; Gomes, L.C. Using Lactobacilli to Fight Escherichia Coli and Staphylococcus Aureus Biofilms on Urinary Tract Devices. Antibiotics 2021, 10, 1525, doi:10.3390/antibiotics10121525.
16. Stewart, E.; Hochstedler-Kramer, B.R.; Khemmani, M.; Clark, N.M.; Parada, J.P.; Farooq, A.; Doshi, C.; Wolfe, A.J.; Albarillo, F.S. Characterizing the Urobiome in Geriatric Males with Chronic Indwelling Urinary Catheters: An Exploratory Longitudinal Study. Microbiol. Spectr. 2024, 12, e00941-24, doi:10.1128/spectrum.00941-24.
17. Walker, J.N.; Flores-Mireles, A.L.; Pinkner, C.L.; Schreiber, H.L.; Joens, M.S.; Park, A.M.; Potretzke, A.M.; Bauman, T.M.; Pinkner, J.S.; Fitzpatrick, J.A.J.; et al. Catheterization Alters Bladder Ecology to Potentiate Staphylococcus Aureus Infection of the Urinary Tract. Proc. Natl. Acad. Sci. 2017, 114, E8721–E8730, doi:10.1073/pnas.1707572114.
18. Gaston, J.R.; Johnson, A.O.; Bair, K.L.; White, A.N.; Armbruster, C.E. Polymicrobial Interactions in the Urinary Tract: Is the Enemy of My Enemy My Friend? Infect Immun 2021, 89, doi:10.1128/iai.00652-20.
19. Akhlaghpour, M.; Haley, E.; Parnell, L.; Luke, N.; Mathur, M.; Festa, R.A.; Percaccio, M.; Magallon, J.; Remedios-Chan, M.; Rosas, A.; et al. Urine Biomarkers Individually and as a Consensus Model Show High Sensitivity and      Specificity for Detecting UTIs. BMC Infect Dis 2024, 24, 153, doi:10.1186/s12879-024-09044-2.
20. Parnell, L.K.D.; Luke, N.; Mathur, M.; Festa, R.A.; Haley, E.; Wang, J.; Jiang, Y.; Anderson, L.; Baunoch, D. Elevated UTI Biomarkers in Symptomatic Patients with Urine Microbial Densities of 10,000 CFU/ML Indicate a Lower Threshold for Diagnosing UTIs. MDPI 2023, 13, 1–15, doi:10.3390/diagnostics13162688.
21. Miller, W.R.; Arias, C.A. ESKAPE Pathogens: Antimicrobial Resistance, Epidemiology, Clinical Impact and Therapeutics. Nat. Rev. Microbiol. 2024, 22, 598–616, doi:10.1038/s41579-024-01054-w.
22. Sasirekha, B. Prevalence of ESBL, AmpC β-Lactamases and MRSA among Uropathogens and Its Antibiogram. EXCLI J. 2012, 12, 81–88.
23. Gajdács, M.; Ábrók, M.; Lázár, A.; Burián, K. Increasing Relevance of Gram-Positive Cocci in Urinary Tract Infections: A 10-Year Analysis of Their Prevalence and Resistance Trends. Sci Rep-uk 2020, 10, 17658, doi:10.1038/s41598-020-74834-y.
24. Park, J.W.; Lee, H.; Kim, J.W.; Kim, B. Characterization of Infections with Vancomycin-Intermediate Staphylococcus Aureus (VISA) and Staphylococcus Aureus with Reduced Vancomycin Susceptibility in South Korea. Sci. Rep. 2019, 9, 6236, doi:10.1038/s41598-019-42307-6.
25. PM, Y.D.P. Challenges in the Laboratory Diagnosis and Clinical Management of Heteroresistant Vancomycin Staphylococcus Aureus (HVISA). Clin. Microbiol.: Open Access 2015, 2015, doi:10.4172/2327-5073.1000214.
26. Mohajer, M.A.; Musher, D.M.; Minard, C.G.; Darouiche, R.O. Clinical Significance of Staphylococcus Aureus Bacteriuria at a Tertiary Care Hospital. Scand. J. Infect. Dis. 2013, 45, 688–695, doi:10.3109/00365548.2013.803291.
27. Mylotte, J.M.; Tayara, A.; Goodnough, S. Epidemiology of Bloodstream Infection in Nursing Home Residents: Evaluation in a Large Cohort from Multiple Homes. Clin. Infect. Dis. 2002, 35, 1484–1490, doi:10.1086/344649.
28. Lafon, T.; Padilla, A.C.H.; Baisse, A.; Lavaud, L.; Goudelin, M.; Barraud, O.; Daix, T.; Francois, B.; Vignon, P. Community-Acquired Staphylococcus Aureus Bacteriuria: A Warning Microbiological Marker for Infective Endocarditis? BMC Infect. Dis. 2019, 19, 504, doi:10.1186/s12879-019-4106-0.
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About the Author

Dr. Emery Haley is a scientific writing specialist with over ten years of experience in translational cell and molecular biology. As both a former laboratory scientist and an experienced science communicator, Dr. Haley is passionate about making complex research clear, approachable, and relevant. Their work has been published in over 10 papers and focuses on bridging the gap between the lab and real-world patient care to help drive better health outcomes.

Urologists

Primary Care Physicians

Gastroenterologists

Gynecologists

Medical Directors

Post-Acute Care

Healthcare at Home

Urology Clinic

Immediate Care/Urgent Care

Telemedicine

S. aureus

CHECK BACK SOON FOR OUR FULL BLOG ON THE IMPORTANCE OF STAPHYLOCOCCUS AUREUS

Clinical Summary

Bacterial Characteristics

Gram-stain

Morphology

Growth Requirements

Nitrate Reduction

Urease

Biofilm Formation

Pathogenicity

Clinical Relevance in UTI

Treatment

References

About the Author

Urologists

Primary Care Physicians

Gastroenterologists

Gynecologists

Medical Directors

Post-Acute Care

Healthcare at Home

Urology Clinic

Immediate Care/Urgent Care

Telemedicine

CHECK BACK SOON FOR OUR FULL BLOG ON THE IMPORTANCE OF STAPHYLOCOCCUS AUREUS

Clinical Summary

Bacterial Characteristics

Gram-stain

Morphology

Growth Requirements

Nitrate Reduction

Urease

Biofilm Formation

Pathogenicity

Clinical Relevance in UTI

Treatment

References

About the Author

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