Corynebacterium striatum is a nosocomial opportunistic pathogen increasingly associated with a wide range of human infections and is often resistant to several antibiotics. We investigated the susceptibility of 63 C. All strains were susceptible to vancomycin, linezolid, and daptomycin. High rates of resistance to penicillin Fifty-nine Twenty-nine resistance profiles were distinguished among the 59 resistant C.
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Corynebacterium striatum is an emerging multidrug-resistant bacteria. We retrospectively identified isolates in a clinical database. Clinical relevance, in vitro susceptibility, and length of parenteral antimicrobial drug use were obtained from patient records. For patients with hardware- or device-associated infections, those with C.
When isolated from hardware or devices, C. Patients with hardware-associated C. Corynebacteria are a normal component of the microbiota of human skin and mucous membranes. Although C.
Determination of whether an isolate represents infection, colonization, or contamination is based upon clinical judgment. Although early reports indicated that C. To clarify the spectrum of disease associated with C. For patients with device-associated infections, we compared the length of parenteral therapy for C.
Because we were interested in whether C. Our algorithm-based method was confirmed by using a manual chart review. Corynebacteria were identified to the species level if isolated in pure culture or if deemed to be clinically meaningful if present in a polymicrobial culture.
Because breakpoints have recently changed 21 , we tested whether shifting the breakpoint would alter our results. Susceptibilities were available for penicillin, ciprofloxacin, clindamycin, erythromycin, and tetracycline. We obtained the following variables from chart review by manual extraction: patient location when the culture was obtained i.
If the treating physician did not comment on the isolate, the isolate was categorized as clinically irrelevant. Adverse events were defined as clinical event necessitating a change in antimicrobial agent and were graded according to the Common Terminology for Adverse Events Serious adverse events were considered grade 3 or 4. The outpatient parenteral antimicrobial therapy practices at the University of Washington Medical Center monitor for adverse events by weekly measurement of a complete blood count and monitoring of renal function.
We used these weekly measurements as a proxy to verify ongoing administration of outpatient parenteral therapy in combination with review of documentation in clinical notes.
Persons infected with coagulase-negative staphylococci were chosen as controls because isolates are frequently found in clinical samples enabling appropriate matching , colonize the skin, and generally have low virulence, similar to C.
We identified immunocompetent adult patients infected with C. Consistent with previous reports that C. Interpretation of clinical relevance varied markedly by sample site. No clinical failures for vancomycin therapy were documented. Patients infected with Corynebacterium striatum , by specimens isolated from a particular anatomic site, at the University of Washington Medical Center, Seattle, Washington, USA, — Hardware, surgical specimen obtained from a location anatomically in connection with a foreign device; BAL, bronchoalveolar lavage; urine, specimen isolated from a urine sample we were unable to determine presence or absence of a catheter ; surgical site, deep surgical specimen; skin, wound swab from a nonsurgical superficial specimen.
Numbers A and percentages B of Corynebacterium striatum isolates from patients at the University of Washington Medical Center, Seattle, Washington, USA, —, with a multidrug-resistant phenotype for all antimicrobial drugs tested penicillin, ciprofloxacin, clindamycin, erythromycin, and tetracycline. Inpatient or outpatient indicates clinical setting in which cultures were performed. We determined in vitro susceptibilities for several antimicrobial drugs Table.
Initial MICs for daptomycin were 0. All patients with infections deemed to be clinically relevant were initially given vancomycin, except 1 patient with a documented allergy to vancomycin who received daptomycin. As expected, the length of time parenteral antimicrobial drugs were administered varied widely by anatomic site of infection and presence of a foreign body. In a subset restricted to the 38 patients with hardware including prosthetic joint or device-associated infections deemed clinically meaningful, we successfully matched 27 patients with control patients infected with coagulase-negative staphylococci.
Eleven patients could not be matched for site of infection or age. When we compared control patients infected with coagulase-negative staphylococci with patients infected with C. Horizontal lines within boxes indicate median values, whiskers indicate minimum and maximum values, and boxes indicate 25th and 75th percentiles. Mean durations of parenteral antimicrobial drug use for patients infected with C. CoNS, coagulase-negative staphylococci. Five serious adverse events were associated with parenteral antimicrobial drugs in the C.
Because C. Previous investigations have described C. Our report documents that clinicians encountering C. Prior studies of small groups of patients have indicated that isolation of C. Furthermore, our study provides support for the pathogenic role of C. In contrast to some reports in which isolation from a respiratory sample was frequently determined to be clinically relevant 15 , 27 , 28 , less than half of the respiratory isolates in our study were considered to reflect lower respiratory tract infections.
We documented that a multidrug-resistant phenotype of C. Osteomyelitis and hardware-associated infections are difficult to treat, often requiring a prolonged course of antimicrobial drugs. In some situations, guidelines recommend a limited duration of parenteral therapy followed by a longer period of oral therapy A lack of well-tolerated oral treatment options active against C.
The longer that parenteral antimicrobial therapy is necessary, the greater the likelihood of adverse events associated with intravenous access. Although we documented more adverse events associated with treatment in the C. Furthermore, parenteral therapy is associated with substantially increased costs, even when comparing an inexpensive parenteral antimicrobial drug vancomycin with an expensive oral antimicrobial drug linezolid In addition, parenteral options for C.
Because daptomycin resistance can emerge rapidly, it is reasonable to assume that increased daptomycin use could also cause resistance to this drug. One oral treatment option for multidrug-resistant C.
Although testing for C. None of our patients in our study were treated with linezolid for a prolonged time, which most likely reflects reluctance of physicians to use an agent with such a high rate of toxicity. We demonstrated that multidrug resistance was common even in isolates that were not considered to be clinically meaningful in an outpatient setting. We hypothesize that these resistant strains of C. Strengths of our study include a systems-wide approach to C. Limitations of our study include its retrospective nature and use of data from 1 health system, which restricted potential generalizability of the results.
Given that our study was a retrospective study conducted over a year period, we also cannot state whether the isolates are clonally related or reflect a diverse group with divergent mechanisms of drug resistance. We have no other way of determining whether the isolate was causing disease, but we believe that this limitation is indicative of general clinical practice. Determining causality would require a different series of mechanistic investigations. Our study demonstrates that C. Our results highlight the need to identify corynebacteria to the species level, which is now readily performed by using MALDI-TOF mass spectrometry, and perform susceptibility testing for any isolate that is believed to be clinically meaningful.
The frequent resistance of C. His primary research interest is host—pathogen interactions. Multidrug-resistant Corynebacterium striatum associated with increased use of parenteral antimicrobial drugs. Emerg Infect Dis. National Center for Biotechnology Information , U.
Journal List Emerg Infect Dis v. William O. Hahn , Brian J. Werth , Susan M. Butler-Wu , 1 and Robert M. Author information Copyright and License information Disclaimer. Corresponding author. Address for correspondence: Robert M. Copyright notice. This article has been cited by other articles in PMC. Abstract Corynebacterium striatum is an emerging multidrug-resistant bacteria.
Keywords: Corynebacterium striatum, bacteria, antimicrobial resistance, multidrug resistance, parenteral antimicrobial drugs. Bacterial Identification and In Vitro Drug Susceptibility Testing Corynebacteria were identified to the species level if isolated in pure culture or if deemed to be clinically meaningful if present in a polymicrobial culture. Clinical Data Extraction We obtained the following variables from chart review by manual extraction: patient location when the culture was obtained i.
Results We identified immunocompetent adult patients infected with C. Open in a separate window. Figure 1. Figure 2. Figure 3. Discussion Because C. References 1. J Clin Microbiol. Multidrug-resistant Corynebacterium successfully treated with daptomycin. Int J Antimicrob Agents.
This study aimed to identify clinical or microbiological factors affecting the clinical relevance of Corynebacterium striatum isolated from blood cultures. A total of 64 isolates from 51 patients identified as C. More than two blood cultures were positive in 25 Diabetes, solid tumor, and a history of previous exposure to antibiotics were more common in patients with multiple positive blood cultures.
A year-old woman visited our emergency department because of exertional dyspnea due to severe left ventricular functional failure. It progressed to disseminated intravascular coagulation and disturbance of consciousness on day 67 of admission. Gram-positive bacilli were detected from two different blood culture samples on day 67 of admission. The bacterium was detected from the removed central venous catheter tip too, and the patient was diagnosed with catheter-related bloodstream infection by C.