Corynebacterium jeikeium bacteremia at a tertiary care center

Clinical Characteristics of Corynebacterium Bacteremia Caused by Different Species, Japan, 2014-2020

Corynebacterium bacteremia is most commonly caused by C. striatum or C. jeikeium.

To determine differences in clinical characteristics of patients with bacteremia caused by Corynebacterium striatum, C. jeikeium, and other species of Corynebacterium, we retrospectively reviewed medical records of patients in Japan who had Corynebacterium bacteremia during January 2014–May 2020. Of the 115 records evaluated, 60 (52%) were cases of true bacteremia and 55 (48%) were cases of contamination. Proportions of true bacteremia cases caused by C. striatum (70%) and by C. jeikeium (71%) were significantly higher than those caused by other species of Corynebacterium (9%). These 2 organisms were commonly detected in blood cultures of patients with hematologic malignancies and neutropenia. The mortality rates at 90 days were 34% (C. striatum), 30% (C. jeikeium), and 0 (other species). Given the high mortality rates, assessing true bacteremia when C. striatum or C. jeikeium is detected in blood cultures, especially in patients with hematologic malignancy, is warranted.

Pyogenic tenosynovitis of the wrist due to Corynebacterium striatum in a patient with dermatomyositis: A case report

INTRODUCTION

Corynebacterium striatum is common contaminant in clinical specimens. Here, we report a rare case of pyogenic tenosynovitis of the wrist caused by C striatum in a dermatomyositis patient taking oral immunosuppressants.

PATIENT CONCERNS

A 67-year-old Japanese woman with dermatomyositis had a history of multiple intraarticular injections of corticosteroids to the right wrist joint for the treatment of osteoarthritis. She was admitted to our hospital with a painful lump on the right dorsal wrist lasting for three months. MRI revealed cellulitis of the dorsum of the right wrist and hand and fluid collection in the extensor tendon sheath. C striatum was detected in the cultures of three samples of synovial fluid taken from the dorsal hand.

DIAGNOSIS

Pyogenic tenosynovitis of the wrist due to C striatum.

INTERVENTIONS

The infection was successfully controlled with synovectomy and adjuvant antibiotic therapy.

OUTCOMES

There has been no sign of recurrence for 12-months after the surgical treatment.

LESSONS

This is the first reported case of pyogenic tenosynovitis due to C striatum in a patient with dermatomyositis. Clinicians should be aware that patients undergoing immunosuppressive therapy have a risk of C striatum infection.

From contamination to infective endocarditis-a population-based retrospective study of Corynebacterium isolated from blood cultures

Corynebacterium is a genus that can contaminate blood cultures and also cause severe infections like infective endocarditis (IE). Our purpose was to investigate microbiological and clinical features associated with contamination and true infection. A retrospective population-based study of Corynebacterium bacteremia 2012–2017 in southern Sweden was performed. Corynebacterium isolates were species determined using a matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Patient were, from the medical records, classified as having true infection or contamination caused by Corynebacterium through a scheme considering both bacteriological and clinical features and the groups were compared. Three hundred thirty-nine episodes of bacteremia with Corynebacterium were identified in 335 patients of which 30 (8.8%) episodes were classified as true infection. Thirteen patients with true bacteremia had only one positive blood culture. Infections were typically community acquired and affected mostly older males with comorbidities. The focus of infection was most often unknown, and in-hospital mortality was around 10% in both the groups with true infection and contamination. Corynebacterium jeikeium and Corynebacterium striatum were significantly overrepresented in the group with true infection, whereas Corynebacterium afermentans was significantly more common in the contamination group. Eight episodes of IE were identified, all of which in patients with heart valve prosthesis. Six of the IE cases affected the aortic valve and six of seven patients were male. The species of Corynebacterium in blood cultures can help to determine if a finding represent true infection or contamination. The finding of a single blood culture with Corynebacterium does not exclude true infection such as IE.

Retrospective evaluation of the clinical characteristics associated with Corynebacterium species bacteremia

Objectives

Corynebacterium spp. are becoming recognized as pathogens that potentially cause various infections. We aimed to evaluate the clinical characteristics associated with Corynebacterium spp. bacteremia.

Patients and methods

We retrospectively reviewed the medical records of all adult patients who had positive blood cultures for Corynebacterium spp. in a single university hospital between January 2014 and December 2016. Patients were divided into a bacteremia group and a contamination group based on microbiological test results and clinical characteristics. Patients’ characteristics, antimicrobial susceptibility of isolated species, antimicrobials administered, and patient outcomes were evaluated.

Results

Corynebacterium spp. were isolated from blood samples of 63 patients; Corynebacterium striatum was the predominant isolate. Twenty-eight patients were determined to have bacteremia. Younger age (p = 0.023), shorter time to positivity (p = 0.006), longer hospital stay (p = 0.009), and presence of an indwelling vascular catheter (p = 0.002) were observed more often in the bacteremia group compared to the contamination group. The source of infection in most patients with bacteremia was an intravenous catheter. All tested strains were susceptible to vancomycin. Four of the 27 patients with bacteremia died, despite administration of appropriate antimicrobial therapy.

Conclusions

We found that younger age, shorter time to positivity, and presence of an indwelling catheter were related to bacteremia caused by Corynebacterium spp. Appropriate antimicrobials should be administered once Corynebacterium spp. are isolated from the blood and bacteremia is suspected.

Clinical characteristics and predictive factors for mortality in coryneform bacteria bloodstream infection in hematological patients

BACKGROUND

We examined the clinical characteristics and predictive factors for mortality in coryneform bacteria bloodstream infection in hematological patients.

METHODS

We searched for hematological patients who had positive blood cultures for coryneform bacteria at our center between April 2007 and January 2016. Patients with definite bloodstream infections were included. We started species identification in April 2014.

RESULTS

Twenty of twenty-eight cases with a positive blood culture for coryneform bacteria were regarded as definite infections. Sixteen and two patients were allogeneic and autologous hematopoietic stem cell transplantation (HSCT) recipients, respectively. Corynebacterium striatum was identified in all nine of the cases tested and one patient was co-infected with Corynebacterium amycolatum. None of the patients died directly due to coryneform bacteria infection. The survival rates at 30, 60 and 180 days were 100%, 73.7% and 51.3%, respectively. Causes of mortality included progression of the underlying disease (n = 6), other infections (n = 4) and HSCT complications (n = 2). Mixed infection (hazard ratio (HR) 5.47, 95% confidence interval (CI) 1.30-23.0), renal impairment (HR 6.31, 95% CI 1.06-37.4) and absence of a central venous (CV) catheter at the onset (HR 6.39, 95% CI 1.04-39.45) were identified as predictive factors for mortality.

CONCLUSION

Most of the coryneform bacteria bloodstream infections occurred in HSCT recipients. Contamination seemed to be less common when coryneform bacteria were detected in blood in hematological patients. Although coryneform bacteria bloodstream infection seemed to mostly be manageable, the prognosis was not desirable, particularly in patients with mixed infection, renal impairment and absence of a CV catheter.

New Insight on Epidemiology and Management of Bacterial Bloodstream Infection in Patients with Hematological Malignancies

Bloodstream infections (BSI) are a significant cause of morbidity and mortality in onco-hematologic patients. The Gram-negative bacteria were the main responsible for the febrile neutropenia in the sixties; their impact declined due to the use of fluoroquinolone prophylaxis. This situation was followed by the gradual emergence of Gram-positive bacteria also following the increased use of intravascular devices and the introduction of new chemotherapeutic strategies. In the last decade, the Gram-negative etiology is raising again because of the emergence of resistant strains that make questionable the usefulness of current strategies for prophylaxis and empirical treatment. Gram-negative BSI attributable mortality is relevant, and the appropriate empirical treatment significantly improves the prognosis; on the other hand the adequate delayed treatment of Gram-positive BSI does not seem to have a high impact on survival. The clinician has to be aware of the epidemiology of his institution and colonizations of his patients to choose the most appropriate empiric therapy. In a setting of high endemicity of multidrug-resistant infections also the choice of targeted therapy can be a challenge, often requiring strategies based on off-label prescriptions and low grade evidence.

In this review, we summarize the current evidence for the best targeted therapies for difficult to treat bacteria BSIs and future perspectives in this topic. We also provide a flow chart for a rational approach to the empirical treatment of febrile neutropenia in a multidrug resistant, high prevalence setting.

Estimation of cultivable bacterial diversity in the cloacae and pharynx in Eurasian griffon vultures (Gyps fulvus)

In this work, we describe the biodiversity of cloacal and pharynx culture-based bacteria (commensal and pathogenic), in 75 Eurasian griffon vultures (Gyps fulvus) from two geographic areas. We address the question of whether the cultivable microbiota of vultures is organised into assemblages occurring by chance. In addition, we assess bacterial diversity in both anatomic regions and geographic areas. Bacterial diversity was represented by 26 Gram-negative and 20 Gram-positive genera. The most common genera were Escherichia, Enterococcus, Staphylococcus, Clostridium and Lactococcus. Escherichia coli and Enterococcus faecalis were the most common species in cloacal and pharyngeal samples. Staphylococcus and Erysipelothrix were isolated from the pharynx and Salmonella and Corynebacterium from the cloacae, and no Campylobacter was isolated from the cloacal swabs. Ten cloacal swabs were positive for Salmonella, of which five isolates were Salmonella enterica serotype 4,(5),12:i:-, one isolate was S. enterica serotype Derby, three isolates were S. enterica serotype 61:k:1,5,7 and one isolate was S. enterica serotype Infantis. The null modelling approach revealed that the commensal bacteria of vultures are not structured in assemblages. On the other hand, differences in bacterial genus and species richness between cloacal and pharyngeal samples or between geographic areas were clear, with the pharynx in vultures from both geographic areas being richer. The results of this study indicate also that vultures can serve as a reservoir of certain pathogenic zoonotic bacteria. The dissemination of these zoonotic pathogens in wildlife could be prevented by periodic sanitary surveys.

Tigecycline treatment of multi-drug-resistant Corynebacterium jeikeium infection in a child with relapsing and refractory acute lymphoblastic leukemia

Corynebacterium jeikeium has been recognized as an important cause of infection, particularly among neutropenic patients who have central venous catheter (CVC). Routine use of tigecycline in children is not yet approved. Here in we present a child with relapsed-refractory lymphoblastic leukemia who was successfully treated with tigecyline due to multi-drug-resistant C. jeikeium sepsis without removal of CVC. Our case highlights the use of tigecycline where there are no alternatives. Further studies regarding the efficacy and safety of tigecycline in pediatric patients are needed.

Corynebacterium jeikeium bacteremia in a hemodialyzed patient

Corynebacterium jeikeium, frequently encountered in clinical specimens, is part of the normal skin flora. Nevertheless, a few cases of C. jeikeium bacteremia followed by severe clinical manifestations have been reported. C. jeikeium has been reported to cause endocarditis, septicemia, meningitis, pneumonia and osteomyelitis, along with soft tissue and trauma infections. Herein we describe a case of C. jeikeium bacteremia in Greece. The isolation of a coryneform bacterium from a clinical specimen should not immediately be considered a superinfection by the skin flora. Clinical and laboratory investigations are essential in order to evaluate such cases before applying appropriate treatment. On the other hand, the association of coryneform bacteria and disease should be critically investigated, with a thorough identification of the strain, ideally beyond the classical methods, at a specialized center.

Infections caused by coryneform bacteria in pediatric oncology patients

BACKGROUND

Invasive infections caused by coryneform bacteria are uncommon but have been reported with increasing frequency in recent decades, especially in immunocompromised persons. Because pediatric experience is limited, we examined the epidemiology and clinical characteristics of these infections in children undergoing cancer therapy.

METHODS

Using strict case definitions, 17 coryneform bacterial infections were identified in 16 children during a 13-year period; there were 12 episodes of bacteremia and 5 skin or soft tissue infections.

RESULTS

The median age of children with bloodstream infections was 11.2 years, and that of children with skin or soft tissue infections was 3.5 years. Most were receiving cancer therapy at the time of their infections, were outpatients at the onset of their infections, had central venous catheters, and were not neutropenic. No patient died as a result of infection and most had relatively mild signs and symptoms. All patients responded promptly to antimicrobial therapy and, although 3 infections relapsed, there was only 1 serious complication. The most common species isolated were Corynebacterium striatum, C. amycolatum, and Microbacterium species.

CONCLUSIONS

The epidemiologic and clinical features of coryneform bacterial infections in immunocompromised children differ in several important respects from the previously reported characteristics of these infections in adults.

Peptide-like substances as antimicrobial barriers to Corynebacterium sp. adhesion to silicone catheters

AIMS

To show medical application of antimicrobial peptides such as Pep5 and epidermin in inhibiting adhesion of Corynebacterium spp. to silicone catheters.

METHODS AND RESULTS

The inhibitory activity of crude preparations of Pep5 and epidermin was tested on Corynebacterium spp. isolated from catheter-related infections. The addition of these substances at 640 AU ml(-1) to a cell suspension of Corynebacterium sp. 633544 resulted in a decrease of 3 log cycles in the number of viable cells over a period of 12 h. When Pep5 and epidermin were added to in vitro catheter colonization experiments, there was a decrease of 1 log unit (P < 0.01) in the cell number of Corynebacterium spp. adhered to silicone catheters. Scanning electron microscopy revealed that antimicrobial-treated catheters presented zones with absence of adhered cells, and some parts of the catheter presented aggregates suggesting damaged cells.

CONCLUSIONS

The crude preparations of Pep5 and epidermin were able to inhibit Corynebacterium sp. 633544 isolated from catheter-related infection. The capability of Pep5 and epidermin to inhibit catheter colonization may indicate their usefulness as a barrier to block or to reduce the bacteremia by Corynebacterium spp.

SIGNIFICANCE AND IMPACT OF THE STUDY

Peptide-like antimicrobial substances used to reduce bacterial attachment to medical devices may represent a novel strategy to control catheter-related infections.

Corynebacterium jeikeium sepsis after 8-methoxypsolaren photopheresis for cutaneous T-cell lymphoma

We describe a patient with cutaneous T-cell lymphoma who developed Corynebacterium jeikeium sepsis after experimental treatment with 8-methoxypsolaren. The epidemiology and clinical features of C. jeikeium infection are discussed. The patient was successfully treated with intravenous vancomycin without recurrence.

Corynebacterium jeikeium bacteremia in bone marrow transplant patients with Hickman catheters

Prior studies suggest that Corynebacterium jeikeium bacteremia in immunocompromised patients results in frequent morbidity that may be decreased by prompt removal of the indwelling catheter. To summarize recent experience, charts of 53 bone marrow transplant recipients with Hickman catheters and C. jeikeium bacteremia were reviewed. Forty-one patients were treated with vancomycin without catheter removal and 10 patients underwent catheter removal with subsequent vancomycin therapy. No patient in either group died with C. jeikeium bacteremia as the proximate cause. Salvage of the intravascular catheter was successful in 38 of 41 (93%) attempts. Three patients (7%) in the catheter-salvage group and one patient (10%) in the catheter-removal group experienced recurrent bacteremia. In both catheter-salvage and catheter-removal groups, median time to negative blood culture was 2 days. Thus, time to clearance of bacteremia and patient clinical outcome did not differ between treatment groups. In many patients with Hickman catheters, C. jeikeium bacteremia may be treated successfully with vancomycin and without removal of the catheter.

Clinical microbiology of coryneform bacteria

Coryneform bacteria are aerobically growing, asporogenous, non-partially-acid-fast, gram-positive rods of irregular morphology. Within the last few years, there has been a massive increase in the number of publications related to all aspects of their clinical microbiology. Clinical microbiologists are often confronted with making identifications within this heterogeneous group as well as with considerations of the clinical significance of such isolates. This review provides comprehensive information on the identification of coryneform bacteria and outlines recent changes in taxonomy. The following genera are covered: Corynebacterium, Turicella, Arthrobacter, Brevibacterium, Dermabacter. Propionibacterium, Rothia, Exiguobacterium, Oerskovia, Cellulomonas, Sanguibacter, Microbacterium, Aureobacterium, "Corynebacterium aquaticum," Arcanobacterium, and Actinomyces. Case reports claiming disease associations of coryneform bacteria are critically reviewed. Minimal microbiological requirements for publications on disease associations of coryneform bacteria are proposed.

A papular eruption secondary to infection with Corynebacterium jeikeium, with histopathological features mimicking botryomycosis

Corynebacterium jeikeium has been increasingly recognized as a pathogen, particularly in immunocompromised patients and in those with a prosthetic heart valve. Although cutaneous manifestations of C. jeikeium infection have been described, we have only found two case reports that give an histological description of the lesions. We present three patients with haematological malignancies who developed infection with C. jeikeium and a papular eruption. Skin biopsy disclosed similar histological features in all three patients, namely numerous Gram-positive bacteria enclosed in an eosinophilic matrix, with a minimal inflammatory response. C. jeikeium was cultured from cutaneous lesions in two cases.

Recovery of uncommon bacteria from blood: association with neoplastic disease

Table 6 is a summary of the organisms discussed with a listing of the environmental source, the endogenous source, the predisposing factors including neoplasms, and the postulated mechanisms by which the organism can gain access to the circulation. The evidence considered indicates that the entrance of one of these microorganisms into the bloodstream of a human being depends on the presence of multiplicity of predisposing factors. In the majority of cases of bacteremia due to one of these unusual organisms, two or more predisposing factors are present. Certain predisposing factors, such as cancer chemotherapy or intravenous catheterization, often provide a barrier break, while others, such as liver disease, may render the host immune system less capable of clearing organisms from the circulation. For organisms such as Campy-lobacter, Listeria, and Salmonella spp., attributes that allow the invasion of a healthy host are present and seem to be enhanced by the simultaneous presence of a predisposing condition, such as liver disease, in the host. Although somewhat fragmentary, a number of individual case reports describe bacteremia due to one of these organisms occurring weeks to years after surgery and after other therapeutic measures had effected a supposed cure of a cancer. It may be speculated that cancer patients, even after a cure, are still susceptible to bloodstream invasion by one of the aforementioned organisms by virtue of the presence of one or more predisposing metabolic, physiologic, or immunologic factors, even though these factors may be cryptic. The predominance of hematologic malignancies among cases of bacteremia due to these unusual organisms is also apparent. Although, as pointed out by Keusch (169), the reduction in the performance of immune function in hematologic malignancies compared with solid tumors is likely to be responsible, other associations of certain organisms with specific neoplasms warrant further examination. The frequency of bloodstream infections of Salmonella typhimurium and Capno-cytophaga canimorsus in Hodgkin's disease patients seems likely due to a particular mechanism which infection by these species is favored. The specific nature of these mechanisms remains to be determined. The recovery of any unusual bacterium from blood should warrant a careful consideration of the possibility of underlying disease, especially cancer. Microbiologists should advise clinicians of the unusual nature of the identified organism and provide the counsel that certain neoplastic processes, often accompanied by neutropenia, render the human host susceptible to invasion by almost any bacterium. The recovery of such organisms as C. septicum or S. bovis should prompt the clinician to aggressively seek to identify an occult neoplasm if one has not yet been diagnosed.

Corynebacterium CDC group JK (Corynebacterium jeikeium) sepsis in haematological patients: a report of three cases and a systematic literature review

We describe 3 patients with Corynebacterium jeikeium sepsis in neutropenic phase during treatment for acute myeloid leukaemia. Fever was the first symptom. All had a central venous catheter which was removed. Two patients developed subcutaneous nodules containing pus when the neutrophil count recovered; 1 had intracutaneous and pulmonary lesions. They were treated with vancomycin and recovered when the neutrophil count started to rise. A review of 80 neutropenic patients with C. jeikeium sepsis reported in the literature, together with our 3 cases indicates that risk factors for infection are the presence of a central venous catheter, being an adult male or postmenopausal female, profound and prolonged neutropenia and exposure to multiple antibiotics. Skin lesions are reported in 48% and pulmonary lesions in 36% of the patients. The overall mortality is 34% but in patients with recovery of the bone marrow only 5%. Therefore haematopoietic growth factors should be considered in neutropenic patients with C. jeikeium infection.

Production of extracellular slime by coryneforms colonizing hydrocephalus shunts

Corynebacterium spp. are responsible for an important minority of cases of colonization of cerebrospinal fluid shunts used for the treatment of hydrocephalus. In common with coagulase-negative staphylococci, they present a serious therapeutic problem because they are often resistant to multiple antibiotics. We studied the morphologies of coryneforms in colonized hydrocephalus shunts removed from patients and observed extracellular slime similar in appearance to that seen in coagulase-negative staphylococci. We also studied a series of such isolates from other cases of hydrocephalus shunt colonization using an established laboratory model and consistently observed slime production in these shunts as well. We propose that this might be a further reason for failure to eradicate these organisms without shunt removal as well as a factor in their pathogenesis in device-related infections.