Antimicrobial treatment of Corynebacterium striatum invasive infections: a systematic review.

The aim of this study was to establish an evidence-based guideline for the antibiotic treatment of Corynebacterium striatum infections. Several electronic databases were systematically searched for clinical trials, observational studies or individual cases on patients of any age and gender with systemic inflammatory response syndrome, harboring C. striatum isolated from body fluids or tissues in which it is not normally present. C. striatum had to be identified as the only causative agent of the invasive infection, and its isolation from blood, body fluids or tissues had to be confirmed by one of the more advanced diagnostic methods (biochemical methods, mass spectrometry and/or gene sequencing). This systematic review included 42 studies that analyzed 85 individual cases with various invasive infections caused by C. striatum. More than one isolate of C. striatum exhibited 100% susceptibility to vancomycin, linezolid, teicoplanin, piperacillin-tazobactam, amoxicillin-clavulanate and cefuroxime. On the other hand, some strains of this bacterium showed a high degree of resistance to fluoroquinolones, to the majority majority of ß-lactams, aminoglycosides, macrolides, lincosamides and cotrimoxazole. Despite the antibiotic treatment, fatal outcomes were reported in almost 20% of the patients included in this study. Gene sequencing methods should be the gold standard for the identification of C. striatum, while MALDI-TOF and the Vitek system can be used as alternative methods. Vancomycin should be used as the antibiotic of choice for the treatment of C. striatum infections, in monotherapy or in combination with piperacillin-tazobactam. Alternatively, linezolid, teicoplanin or daptomycin may be used in severe infections, while amoxicillin-clavulanate may be used to treat mild infections caused by C. striatum.

Corynebacterium Species of the Conjunctiva and Nose: Dominant Species and Species-Related Differences of Antibiotic Susceptibility Profiles.

PURPOSE: Nondiphtherial Corynebacterium species are normal residents of human skin and mucosa, including the conjunctiva and nose, but can cause conjunctivitis and keratitis. Recently, resistance against various classes of antibiotics has been reported in Corynebacterium. The present study investigated the type of species and antibiotic susceptibilities of the conjunctival and nasal Corynebacterium species. METHODS: This study examined 183 strains of Corynebacterium species that were isolated from patients undergoing preoperative examinations for cataract surgery. Species were identified by RNA polymerase ß-subunit-encoding gene (rpoB) sequencing. Antibiotic susceptibility tests were performed by the microdilution method according to the Clinical and Laboratory Standards Institute standard method M45. RESULTS: Corynebacterium macginleyi was the most predominant species (84%; 46 of 55) in the conjunctiva. The 2 major species in the nasal cavity were Corynebacterium accolens and Corynebacterium propinquum (44% and 31%, respectively), followed by Corynebacterium pseudodiphtheriticum (8%), Corynebacterium jeikeium (7%), and C. macginleyi (3%). In contrast to other nasal Corynebacterium species, only C. macginleyi showed a high susceptibility to macrolides. However, among nonconjunctival Corynebacterium species, C. propinquum, was unique in having a high resistance rate to levofloxacin (29%), comparable with that observed in C. macginleyi (36%). Penicillin G and tobramycin showed good susceptibility in almost all strains. CONCLUSIONS: Drug resistance against fluoroquinolones and macrolides was observed in Corynebacterium species, with the antibiotic susceptibility profiles correlating with differences of the species and niche. Nasal and conjunctival Corynebacterium profiles of drug resistance suggest habitat segregation strictly at the species level.

Effects of Corynebacterium bovis on Engraftment of Patient-derived Chronic-Myelomonocytic Leukemia Cells in NSGS Mice.

Modeling chronic myelomonocytic leukemia (CMML) in immunodeficient NSGS mice relies on unique human CMML specimens and consistent murine engraftment. Only anecdotal comments have thus far supported the notion that research data may be altered by Corynebacterium bovis, an opportunistic cutaneous pathogen of immunodeficient mice. C. bovis disseminated by asymptomatic and clinically affected mice with hyperkeratotic dermatitis, resulting in resilient facility contamination and infectious recurrence. Herein we report that, compared with C. bovis PCR-negative counterparts, C. bovis PCR-positive NSGS mice developed periocular and facial hyperkeratosis and alopecia and had reduced metrics indicative of ineffective human CMML engraftment, including less thrombocytopenia, less splenomegaly, fewer CMML infiltrates in histopathologic sections of murine organs, and fewer human CD45+ cells in samples from murine spleen, bone marrow, and peripheral blood that were analyzed by flow cytometry. All CMML model metrics of engraftment were significantly reduced in the C. bovis PCR-positive cohort compared with the - negative cohort. In addition, a survey of comprehensive cancer center practices revealed that most murine facilities do not routinely test for C. bovis or broadly decontaminate the facility or its equipment after a C. bovis outbreak, thus increasing the likelihood of recurrence of invalidated studies. Our findings document that CMML engraftment of NSGS mice is diminished-and the integrity of murine research data jeopardized-by C. bovis infection of immunodeficient mice. In addition, our results indicate that C. bovis should be excluded from and not tolerated in murine facilities housing immunodeficient strains.

Noninferiority field trial for evaluation of efficacy of ciprofloxacin associated with internal teat sealant as dry-off protocol.

The aim of this study was to compare the efficacy of two dry-off protocols: (a) dry cow therapy using ciprofloxacin hydrochloride 400 mg followed by the administration of an internal teat sealant composed of 4 g of bismuth subnitrate, and (b) a positive control using dry cow therapy with 250 mg cephalonium followed by the administration of 2.6 g bismuth subnitrate internal teat sealant. A total of 578 Holstein cows selected from 7 commercial herds were randomly allocated into two groups at drying off: (a) ciprofloxacin hydrochloride 400 mg (CH) associated with ITS, n = 1112 mammary quarters/296 cows, or (b) positive control (PC) = cephalonium (250 mg) associated with ITS, n = 1058 mammary quarters/282 cows). A total of 1787 out of 2170 mammary quarters (82%) had negative culture at drying off. The microorganisms most frequently isolated at drying off were CNS (5.62%), Strep. uberis (1.9%), Corynebacterium spp. (1.8%), and Staphylococcus aureus (1.01%). A total of 465 mammary quarters experienced new intramammary infections (NIMIs), and the main microorganisms causing NIMI were CNS (21.94%), Strep. uberis (17.2%), and Pseudomonas spp. (9.7%). The CH protocol was not inferior to PC, as the cure risk of mammary quarters CH-treated was at the noninferiority limit. However, the mammary quarters treated by CH protocol had 24% and 31% lower risk of overall NIMI and NIMI caused by major pathogens, respectively, than mammary quarters dried with the PC protocol. In addition, the mammary quarters treated with CH protocol had a lower risk of CM through the first 60 DIM than those treated with PC protocol. Both DCT protocols showed similar odds of microbiological cure, but the CH protocol had greater prevention against NIMI during dry-off period.

Sodium butyrate ameliorates Corynebacterium pseudotuberculosis infection in RAW264.7 macrophages and C57BL/6 mice.

Corynebacterium pseudotuberculosis (CP) infection in livestock has become highly difficult to control. To decrease the incidence of CP infection, the supplementation of feed with non-antibiotic antibacterial substances is a potential approach. The aim of this study was to assess the effects of sodium butyrate (NaB), a potential alternative to antibiotics, on CP infection in RAW264.7 macrophages and C57BL/6 mice. Our data showed that NaB (2 mM) significantly ameliorated CPinfection in RAW264.7 macrophages and decreased the bacterial load in the spleens of infected mice. By real-time PCR, we found that NaB induced significant decreases in zinc-dependent superoxide dismutase (sodC) and tip protein C (spaC) expression in CP from infected-RAW264.7 cells and in phospholipase D (pld) and spaC expression in CP from the spleens of infected mice. NaB treatment significantly up-regulated cathelicidin-related antimicrobial peptide (cramp) expression in spleens of mice infected with CP. Furthermore, NaB alleviated histopathological changes in spleens of CP-infected mice. In conclusion, NaB ameliorated CP infection in RAW264.7 macrophages and C57BL/6 mice, and these effects may be related to the modulation of sodC, spaC, pld, and cramp expression.

Treatment considerations for potential uropathogens detected by precision microbiological testing.

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.

Cellulitis and Bacteremia due to Corynebacterium striatum Identified by Matrix-assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry.

Corynebacterium striatum has been described as a pathogen in immunocompromised patients; however, correctly identifying Corynebacterium spp. is often difficult, and cases of cellulitis caused by C. striatum are only rarely reported. We herein describe a case of cellulitis and bacteremia due to C. striatum identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antimicrobial susceptibility testing was performed using the Strepto-Haemo Supplement method, and vancomycin was replaced by a narrow-spectrum oral amoxicillin.

Corynebacterium spp as causative agents of microbial keratitis.

PURPOSE: To report the clinical and microbiological profile of keratitis caused by Corynebacterium spp. METHODS: The medical and microbiology records of 22 patients, who had presented at the L V Prasad Eye Institute, Bhubaneswar, between June 2009 and December 2012, and whose corneal scrapings had yielded significant growth of Corynebacterium spp, were retrospectively reviewed. A detailed ocular examination was performed before the respective corneal scraping was sent for a microbiological work-up. The data collected from each record included age, gender, predisposing factors (ocular and systemic), clinical presentation, management and outcome of treatment. RESULTS: The mean age of the patients was 43.8±24.4 years. Ocular predisposing factor was present in 14 (63.6%) eyes. Surgical intervention was required in 12 (54.5%) patients. In vitro susceptibility (Kirby-Bauer disc diffusion method) results of Corynebacterium spp to vancomycin (17/19, 89.5%), cefazolin (16/20, 80%), chloramphenicol (11/20, 55%), ofloxacin (13/19, 68.4%), ciprofloxacin (10/20, 50%) and gatifloxacin (10/19, 52.6%) were variable. Drug resistance (more than one drug) was seen in nine (40.9%) Corynebacterium isolates, of which, two (22.2%) showed multidrug resistance to three or more classes of antibiotics. CONCLUSIONS: Corynebacteria can cause severe corneal infection requiring surgical intervention.

Clinical features, microbiological profile and treatment outcome of patients with Corynebacterium endophthalmitis: review of a decade from a tertiary eye care centre in southern India.

AIMS: To report the clinical and microbiological profile along with treatment outcome of patients with endophthalmitis caused by Corynebacterium sp. METHODS: This is a retrospective, consecutive, non-comparative case series of patients with culture-proven Corynebacterium endophthalmitis seen between August 2004 and July 2014. RESULTS: Of 5439 patients clinically diagnosed as infective endophthalmitis, vitreous samples were culture positive for bacteria in 1488 (27%). Sixteen patients (1%) were identified as Corynebacterium endophthalmitis. The clinical settings included trauma (n=10), post-cataract surgery (n=5) and post-penetrating keratoplasty (n=1). In 7/16 (44%) patients, the organisms were visualised in direct microscopy. Tested by disc-diffusion method, all isolates were vancomycin sensitive. However, 9 of 10 isolates were resistant to ceftazidime and 5 of 14 isolates were resistant to amikacin. Initial treatment strategies included pars plana vitrectomy with intravitreal antibiotics (vancomycin and amikacin/ceftazidime) injection (n=9) and pars plana lensectomy along with pars plana vitrectomy and intravitreal antibiotics (vancomycin and amikacin/ceftazidime) injection (n=7). Final visual acuity was 20/200 or better in 11 (69%) of 16 patients. CONCLUSIONS: The prevalence of corynebacterial endophthalmitis is low. The organisms are susceptible to vancomycin, and early appropriate treatment results in favourable outcome.

Bacteremia Caused by Corynebacterium amycolatum with a Novel Mutation in gyrA Gene that Confers High-Level Quinolone Resistance / 대한진단검사의학회지

Although Corynebacterium amycolatum can cause opportunistic infections, it is commonly considered as contaminant. In this report, we present a case of bacteremia caused by C. amycolatum with a novel mutation in the gyrA gene that confers high-level quinolone resistance to the organism.

Corynebacterium falsenii bacteremia occurring in an infant on vancomycin therapy.

Corynebacterium falsenii was described in 1998 as a new Corynebacterium species. We give the first detailed description of a clinically significant Corynebacterium falsenii bacteremia occurring in an infant while on vancomycin therapy.

Catheter-related Corynebacterium bacteremia: should the catheter be removed and vancomycin administered?

The purpose of this study was to determine the need for central venous catheter removal in patients with corynebacterial catheter-related bloodstream infections and the impact of central venous catheter retention on response to systemic antibiotic therapy and relapse. We searched the microbiology laboratory database and patients' medical records at our institution between January 2000 and December 2006. We identified 98 patients with corynebacteria infection. Most of the episodes (94%) were catheter-related. Removing the catheter did not affect the outcome of treatment, particularly when an active non-glycopeptide antibiotic was used. All Corynebacterium species isolates were susceptible to vancomycin, 54/55 (98%) to linezolid, 80/95 (84%) to rifampin, and 69/85 (81%) to tetracycline. The median duration of antibiotic therapy was 12 days (range, 0-28), and vancomycin was the most commonly used antibiotic (64%). There was a trend toward earlier fever resolution in patients treated with non-glycopeptide antibiotics compared to vancomycin, particularly if the catheter was not removed. Central venous catheter removal might not be necessary in patients with corynebacterial catheter related bloodstream infection, particularly if systemic therapy consists of non-glycopeptide antibiotics. Treatment with a systemic active antibiotic over a 7-day period appears to be adequate for resolution of the infection.

Cistitis y hematuria por Corynebacterium striatum. A propósito de un caso y revisión de la literatura científica / Cystitis and haematuria due to Corynebacterium striatum. A case report and review

Presentamos un caso de infección del tracto urinario inferior no complicada por Corynebacteriumstriatum en una paciente ambulatoria y sin factores de riesgo predisponentes. C. striatum es una bacteria saprofita de la piel y las mucosas, que se ha relacionado ocasionalmente con la infección en pacientes hospitalizados o inmunodeficientes con enfermedades subyacentes. Concluimos que este microorganismo debe considerarse un patógeno emergente, tanto en pacientes inmunodeficientes como en inmunocompetentes (AU)

We herewith report the first case of uncomplicated urinary tract infection due to Coryne bacterium striatum in an ambulatory patient without any other predisponent risk factors. C. striatum is a ubiquitous saprophyte of human skin and mucous membranes, which has been occasionally associated with infection in patients hospitalized or immunocompromised patients with underlying diseases. We conclude that C. striatum should be considered an emerging pathogen in both immunocompetent and immunocompromised hosts (AU)

Urinary tract infection caused by Corynebacterium urealyticum in a male dog / Infecção do trato urinário por Corynebacterium urealyticum em um cão

Um cão adulto, com histórico de infecção do trato urinário, foi apresentado aos autores. O cão foisubmetido ao exame físico, ultrassonografia, urinálise e cistocentese para cultura bacteriológica. O exame bacteriológico evidenciou a presença de bastonetes Gram positivo em cultura pura como únicomicrorganismo isolado. Provas bioquímicas do isolado confirmaram tratar-se de Corynebacteriumurealyticum. O patógeno mostrou-se susceptível às quinolonas e aos aminoglicosideos, e resistente àmaioria das penicilinas. O tratamento com ciprofloxacina apresentou sucesso.

Multiple abscesses caused by Salmonella enterica and Corynebacterium pseudotuberculosis in a dromedary camel.

A rare case of arthritis, peri-arthiritis and pleurits associated with Salmonella enterica and Corynebacterium pseudotuberculosis infection in a dromedary camel is reported. Articular infections caused by Non-typhoidal Salmonella have been exceptionally described in human medicine. To our knowledge, this would be the first description of articular infections associated with Non-thyphoidal Salmonella in other mammals than humans. Possible pathogenesis of the infection is discussed.

A case of septic shock secondary to Corynebacterium aquaticum bacteremia occurring in an HIV-infected patient attending a promiscuous thermal SPA.

Corynebacterium aquaticum, an environmental organism associated with fresh water, has very seldom proved to be a cause of infection, although it has increasingly been isolated from clinical specimens. This report describes an unusual case of bacteremia occurring in an HIV-infected patient, complicated by septic shock and secondary to an epididimo-orchitis. Combination therapy of levofloxacin and metronidazole was used successfully.

[Etiologic role of Corynebacterium non diphtheriae in patients with different pathology].

Bacteriologic examination of 1589 patients showed that, aside from C. diphtheriae, 11% of acute upper respiratory tract infections were caused by other Corynebacterium species. Such bacteria can cause infections of various localizations (bronchitis, pyelonephritis, urethritis, colpitis, dermatitis, arthritis, etc.). C. pseudodiphtheriticum and C. xerosis were isolated from clinical specimens most frequently. Corynebacterium spp. have adhesive, hemolytic, hemagglutinating, and neuraminidase activity; some of them are highly pathogenic. The most virulent, were following species: C. diphtheriae, C. pseudotuberculosis, C. urealyticum, and C. ulcerans. Corynebacterium non diphtheriae were frequently isolated from clinical specimens in association with staphylococci and streptococci. In such cases, factors of pathogenicity and resistance to antibiotics were more pronounced. Strains isolated with association with other bacteria have lost susceptibility to tetracycline, oleandomycin, penicillin, and erythromycin. It is important to be vigilant about bacteria from Corynebacterium genus in clinical settings, and thoroughly study their biologic characteristics, especially in immunocompromised patients.

Vaccination confers significant protection of sheep against infection with a virulent United Kingdom strain of Corynebacterium pseudotuberculosis.

Using a virulent United Kingdom Corynebacterium pseudotuberculosis isolate, an ovine experimental model of caseous lymphadenitis was developed, in which the manifestation of disease was equivalent to the naturally observed infection in this country. Subsequently, the capacity of several experimental vaccines to protect against experimental challenge was determined. Sheep were immunised with a recombinant derivative of phospholipase D, deriving from the virulent UK isolate, a formalin-killed bacterin of the same strain, or a bacterin supplemented with recombinant phospholipase D. Following homologous experimental challenge, the phospholipase D and bacterin vaccines were observed to confer statistically significant protection against infection, and appeared to restrict dissemination of challenge bacteria beyond the inoculation site in the majority of animals. More importantly, the combined vaccine succeeded in providing absolute protection against infection, whereby challenge bacteria were eradicated from all vaccinates. In addition to the experimental vaccines, a commercially available CLA vaccine, unlicensed for use in the European Union, was assessed for its capacity to protect against heterologous challenge. The vaccine conferred significant protection, although the dissemination of infection beyond the inoculation site was not restricted as it had been with the previous vaccines. However, no animals immunised with this vaccine manifested infection within the lungs; thus, a potentially important route of disease transmission was eliminated. The results of this study provide information pertinent to the development of an effective caseous lymphadenitis vaccination strategy in the UK.

Perianal fistulas in Crohn's disease are predominantly colonized by skin flora: implications for antibiotic treatment?

In this study we aimed to determine the microorganisms found in perianal fistulas in Crohn's disease and whether treatment with ciprofloxacin affects these microorganisms. Thirteen patients (males/females, 7/6; median age, 34 years; range, 18-61 years) with fistulas were treated with infliximab, 5 mg/kg intravenously, at weeks 6, 8, and 12 and randomized to double-blind treatment with ciprofloxacin, 500 mg bd (n = 6), or placebo (n = 7) for 12 weeks. Samples were taken at baseline and at weeks 6 and 18. In the ciprofloxacin group 10 different genera of microorganisms were identified, while 13 genera could be identified in the placebo group. Gram-negative enteric floras were present in a small minority. The genera found in patients with perianal fistulas were predominantly gram-positive microorganisms. Therefore, antimicrobial treatment should be directed toward these microorganisms.

Eagle effect in Corynebacterium diphtheriae.

The in vivo relevance of the paradoxical bactericidal effect (the Eagle effect) is not evident. We found in vitro a paradoxical bactericidal effect of amoxicillin on 2 strains of nontoxigenic Corynebacterium diphtheriae. Then, using an experimental rabbit model of endocarditis, we evaluated the in vivo relevance of this phenomenon. Rabbits were assigned to the following groups: no treatment (control group), continuous amoxicillin infusion simulating a dosage of 200 mg/kg/day in humans, and continuous amoxicillin infusion simulating a dosage of 20 mg/kg/day in humans. The low dosage (20 mg/kg/day) was significantly more effective than the high dosage (200 mg/kg/day) against both strains (P<.025), confirming the paradoxical bactericidal effect observed in vitro.