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.

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.

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.

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.

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.

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.

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.

Corynebacterium urealyticum urinary tract infection in dogs and cats: 7 cases (1996-2003).

OBJECTIVE: To identify clinical features of Corynebacterium urealyticum urinary tract infection in dogs and cats and antimicrobial susceptibility patterns of C urealyticum isolates. DESIGN: Retrospective study. ANIMALS: 5 dogs and 2 cats. PROCEDURE: Medical records of dogs and cats for which C urealyticum was isolated from urine samples were reviewed. Isolates from clinical cases, along with previously lyophilized unsubtyped isolates of Corynebacterium spp collected between 1977 and 1995, were examined and, if subtyped as C urealyticum, tested for antimicrobial susceptibility. RESULTS: Signalment of infected animals was variable. Prior micturition disorders were common, and all animals had signs of lower urinary tract disease at the time C urealyticum infection was diagnosed. Median urine pH was 8.0; WBCs and bacteria were variably seen in urine sediment. In vitro antimicrobial susceptibility testing of 14 C urealyticum isolates revealed that all were susceptible or had intermediate susceptibility to chloramphenicol, tetracycline, and vancomycin and most were susceptible to enrofloxacin. Thickening of the bladder wall and accumulation of sediment were common ultrasonographic findings. Contrast radiography or cystoscopy revealed findings consistent with encrusting cystitis in 3 dogs. Infection resolved in 2 dogs following surgical debridement of bladder plaques and antimicrobial administration. In 2 other dogs and 1 cat treated with antimicrobials, infection with C urealyticum resolved, but urinary tract infection with a different bacterial species developed. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that preexisting urinary tract disorders are common in dogs and cats with C urealyticum infection. Treatment with appropriate antimicrobials in combination with surgical debridement might eliminate C urealyticum infection.

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.

Infection with Corynebacterium pseudotuberculosis in five alpacas.

Among the population of an alpaca breeding farm, 5 alpacas (22 days to 14 months old) developed focal swellings in the subcutaneous tissues of the head or neck. Infection with Corynebacterium pseudotuberculosis was confirmed on the basis of results of microbial culture of abscess material and a serum hemolysis inhibition assay to detect C. pseudotuberculosis toxin. The dams of the affected alpacas were seronegative for C. pseudotuberculosis toxin. The affected alpacas underwent surgical excision of the abscesses and were isolated from herdmates for 90 days; treatment was successful, and no other alpacas in the herd became infected. Common risk factors for sources of infection in the affected alpacas included housing in a maternity barn and a pasture. Also, the infection potentially originated from new alpacas introduced into the herd during the preceding 3 months. Infection with C. pseudotuberculosis should be considered as a differential diagnosis for camelids with peripheral lymphadenopathy or abscesses in subcutaneous tissues.

[Contagious impetigo--pathogen spectrum and therapeutic consequences]. / Impetigo contagiosa--Erregerspektrum und therapeutische Konsequenzen.

OBJECTIVE: The aim of this prospective study was to compare the clinical picture of contagious impetigo (C.I.) with the causative organism and to generate data of the susceptibility of bacteria as the basis for adequate therapy. PATIENTS AND METHODS: In 126 patients with C.I. (86 children, 66 of them younger than 10 years) bacterial swabs were taken and antibiotic sensitivity testing for isolated organisms was tested. RESULTS: In all cases in which contents of vesicles or pustules were analysed, Staphylococcus aureus was the only pathogen isolated. In non-bullous variants of C.I. Staphylococcus aureus was the most often isolated organism as well. Both staphylococci and streptococci were isolated in 12 cases, whereas in just 9 cases streptococci were the only pathogen detected. All Staphylococcus aureus isolates were sensitive to flucloxacillin and cefotaxime. Erythromycin-resistance amounted to more than 20 percent. The percentage of resistant staphylococci against the predominantly topically applied antibiotics fusidinic acid and mupirocin was 2 and 0 per cent, respectively. CONCLUSION: For all manifestations of C.I. Staphylococcus aureus is at present the leading organism which has to be taken into consideration for treatment. If oral antibiotic therapy is indicated, penicillinase-stable penicillins or cephalosporins, preferably of the cefalexin-type, are the drugs of choice. Macrolides are no longer recommended for initiating of C.I. treatment.

Treatment of encrusted cystitis caused by Corynebacterium group D2 with norfloxacin, ciprofloxacin, and teicoplanin in an experimental model in rats.

Oral doses of norfloxacin (80 mg/kg of body weight per day) and ciprofloxacin (25 and 80 mg/kg/day) and intramuscular doses of teicoplanin (5 mg/kg/day), all administered once a day for 10 days, were evaluated as a means of preventing encrusted cystitis caused by Corynebacterium group D2. Zinc disks dipped into a 24-h broth culture of these microorganisms were inserted into the bladders of female Wistar rats, and treatment was started 14 days after bacterial challenge. The appearance of encrusted cystitis was directly related to a documented urinary tract infection by these coryneforms (71.7 and 0% for rats with positive and negative urine cultures, respectively). All rats that died between days 18 to 43 after bacterial challenge presented very severe encrusted cystitis, which was prevented by teicoplanin and high doses of ciprofloxacin. Rats surviving up to day 44 after bacterial challenge were sacrificed; they presented a lower incidence of encrusted cystitis which was also less severe, with teicoplanin and a high dose of ciprofloxacin being more active in reducing the rate of positive cultures (78.8 and 65.7% reduction, respectively). All antibiotics and doses used were active in vivo at preventing encrusted cystitis by Corynebacterium group D2, but the best therapeutic effect was obtained with teicoplanin.

Vancomycin-resistant Corynebacterium species causing prosthetic valve endocarditis successfully treated with imipenem and ciprofloxacin.

Endocarditis caused by a Corynebacterium sp. resistant to vancomycin, penicillin G, erythromycin, gentamicin and rifampicin arose in a 44-year-old woman 4 months after replacement of the mitral valve with a prosthesis. She was successfully treated with a 79-day course of intravenous imipenem and ciprofloxacin and replacement of the prosthesis 48 days after treatment began.

[Corynebacterium group D2. Clinical study, biochemical identification and antibiotic sensitivity]. / Corynebacterium groupe D2. Etude clinique, identification biochimique et sensibilité aux antibiotiques.

The comparative study of 44 isolates of Corynebacterium group D2, from urine, most frequently, shows the pathogenic role of these bacteria in urinary tract infection, with or without urinary stones. These microorganisms have an opportunistic behaviour in other non-urinary sites, and become pathogen in immunosuppressed conditions. The rapid tests as urease, glucose acidification, nitrate reductase, associated with multiple resistance to antibiotics (beta-lactams and aminosides) identify easily Corynebacterium group D2, from 48 h cultures under CO2 conditions. The results of MIC determination of 10 antibiotics, show the high activity (100% sensitivity) of vancomycin and pristinamycin, with MIC modes, respectively, 0.5 and 0.03 mg/l. These antibiotics are the most useful for the treatment of non-urinary infections. Among quinolones, the most active agents are ciprofloxacin and ofloxacin (MIC modes: 4 and 2 mg/l), so these antimicrobials could be used for the treatment of urinary tract infections caused by Corynebacterium group D2.