1/11. Multidrug-resistant corynebacterium striatum pneumonia in a heart transplant recipient.corynebacterium striatum is a rare, but likely underreported, cause of serious infections in immunocompromised hosts and generally is susceptible to multiple classes of antimicrobial agents. Here we report the first case of C. striatum infection in a solid organ transplant recipient. Three years after heart transplantation, a 58-year-old man developed bilateral pneumonia and pulmonary embolism. He did not improve with levofloxacin, piperacillin/tazobactam, and heparin treatment. A homogeneous population of abundant gram-positive rods was repeatedly demonstrated in sputum and bronchoalveolar lavage fluid, and C. striatum was grown in pure culture. The isolate was unusual for its multidrug-resistant (MDR) antimicrobial susceptibility pattern. The pneumonia resolved with 4 weeks of vancomycin therapy, in combination with rifampin given only during the first 2 weeks of treatment. The isolation of coryneforms ("diphtheroids") is often attributed to contamination. Their abundant presence on direct examination of specimens and/or their growth in pure culture suggest a pathogenic role, however, and indicate the need for accurate microbiological identification, particularly in immunocompromised hosts who have been hospitalized and previously treated with antibiotics. Combination therapy that includes vancomycin may be the most prudent treatment for MDR C. striatum infections.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
2/11. Fatal pneumonia caused by corynebacterium group JK after treatment of staphylococcus aureus pneumonia.A 76-year-old man who was admitted to the hospital because of chronic renal insufficiency and chronic hepatitis died of corynebacterium group JK pneumonia, after showing a slight improvement by treatment of staphylococcus aureus with sulbactam/cefoperazone and minocycline. Transtracheal aspiration (TTA) just before his death revealed numerous gram-positive bacilli phagocytized by many neutrophils and more than 10(8) colony forming units (CFU)/ml of corynebacterium group JK. A drug susceptibility test showed corynebacterium group JK was resistant to many antibiotics, with the exception of vancomycin and amikacin.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
3/11. corynebacterium striatum peritoneal dialysis catheter exit site infection.BACKGROUND: Regarded as normal flora of the human skin and mucus membranes, non-diphtheria corynebacteria are frequently dismissed as contaminants or harmless colonizers. Recently, the pathogenic potential of C. striatum has been realized in immunocompromised patients with indwelling medical devices and previous antibiotic exposure. OBJECTIVE: We report here the diagnosis, treatment and clinical outcome of a peritoneal dialysis patient with a C. striatum infection of the catheter exit site. The aim is to present important features to assist in identifying clinically significant infections and provide guidelines for treatment. RESULTS: An immunocompromised patient with previous antimicrobial exposure developed an acute dialysis catheter exit site infection. C. striatum was isolated in pure growth. After initial treatment failure with oral antibiotics and intensified wound care, a satisfactory outcome was ultimately achieved without relapse or loss of the catheter with a 1-month course of vancomycin, 1 g intravenously, administered at 5-day intervals. CONCLUSIONS: The virulent capacity of corynebacterium species should not be underestimated, particularly in high-risk patients. The presence of clinical signs of infection with isolation of the organism in pure culture and the presence of Gram-positive rods on direct Gram stain, especially in association with a leukocyte reaction, supports a cause and effect relationship. Because corynebacteria may be multiresistant, susceptibility testing should be performed on clinically significant isolates. Initial antibiotic selection is influenced by the severity of the infection, however, current experience favors vancomycin in significant infections.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
4/11. corynebacterium striatum: an underappreciated community and nosocomial pathogen.corynebacterium striatum (CS) is an underappreciated human pathogen that has been associated with serious infections in both immunocompetent and immunocompromised hosts. CS infections tend to be more frequent in males and major infection sites have included blood stream, lung, and central nervous system. Most are nosocomially acquired and there is a significant association with medical devices ranging from intravascular catheters to central nervous system drainage devices. Empiric therapy with vancomycin is advisable as susceptibility to other agents is variable. Treatment may also include removal of foreign material such as an intravascular catheter. The present review describes the wide spectrum of infections associated with CS and we add a unique case of CS pancreatic abscess where treatment included linezolid.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
5/11. Demonstration by PCR and dna sequencing of corynebacterium pseudodiphtheriticum as a cause of joint infection and isolation of the same organism from a surface swab specimen from the patient.A case of infectious arthritis following arthroscopy is described. Real-time PCR, using universal bacterial primers targeting the 16S rRNA gene, and subsequent dna sequencing of the PCR product demonstrated the presence of dna from corynebacterium pseudodiphtheriticum in the synovial fluid from the affected knee. culture from a surface swab from the site of purulent discharge from the knee was initially reported as growing normal skin microbiota. Knowing the result of the dna analysis, the specimen was re-examined and a diphtheroid bacterium was isolated. The dna sequence of the isolated bacterium was identical to that of the dna in the joint. The isolated bacterium was tested for susceptibility to relevant antibiotics. Demonstration and identification of bacterial dna by PCR and gene sequencing may not by itself give information on important characteristics such as susceptibility to antibiotics of the infecting bacterium. The present case illustrates that the results obtained by the method can be used to isolate the relevant bacterium in culture from other sites and thereby characterize it. It furthermore demonstrates that C. pseudodiphtheriticum can cause severe arthritis when inoculated into joints.- - - - - - - - - - ranking = 2keywords = susceptibility (Clic here for more details about this article) |
6/11. Tracheobronchitis due to corynebacterium pseudodiphtheriticum.We have presented a case of tracheobronchitis due to C pseudodiphtheriticum in a patient with COPD who was treated with prednisone and apparently was not otherwise immunocompromised. Chronic lung disease seems to predispose to infection with C pseudodiphtheriticum; it can also occur in the immunocompetent host. This organism, when isolated in pure culture, should not be dismissed as a contaminant, but must be considered a possible etiologic agent. Sensitivity of diphtheroids to antibiotics is extremely variable. We believe vancomycin should be used in respiratory tract infections caused by diphtheroids, including C pseudodiphtheriticum, until the results of in vitro antibiotic susceptibility tests are available.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
7/11. corynebacterium pseudodiphtheriticum: a respiratory tract pathogen in adults.corynebacterium pseudodiphtheriticum has been reported to be an uncommon respiratory pathogen. We describe the clinical and microbiologic features of 17 patients from whose sputum C. pseudodiphtheriticum was isolated. patients were identified through a review of the reports from the clinical microbiology laboratory at York Hospital, a community teaching hospital, from October 1990 through April 1993; 17 patients with respiratory infection caused by C. pseudodiphthriticum were identified. There were 12 cases of bronchitis and five of pneumonia. An underlying systemic condition, particularly congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, or malignancy, was common. Onset of symptomatology was acute for most patients, but fever was noticeably absent in almost two-thirds of the cases. Isolates were uniformly susceptible to the beta-lactam antibiotics, vancomycin, and trimethoprim-sulfamethoxazole, but resistance to clindamycin and erythromycin was common. The isolation of diphtheroids from a properly obtained sputum sample from a patient with respiratory tract infection should not always be dismissed as due to contamination. The isolation, identification, and susceptibility testing of C. pseudodiphtheriticum from respiratory tract specimens may provide information useful for treatment of patients.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
8/11. Prosthetic valve endocarditis caused by corynebacterium afermentans subsp. lipophilum (CDC coryneform group ANF-1).Corynebacteria are important causes of endocarditis in individuals with valvular prostheses. We report the first published case of prosthetic valve endocarditis caused by the newly defined species corynebacterium afermentans subsp. lipophilum (former CDC coryneform group ANF-1). The isolate was recovered from a perivalvular abscess specimen and 5 of 15 Bactec blood cultures after 7 to 15 days of incubation. The isolation, identification, and susceptibility testing of corynebacterium species are discussed.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
9/11. Native valve endocarditis due to corynebacterium striatum: case report and review.We report the first known case of native valve endocarditis due to corynebacterium striatum and review 51 previously reported cases of native valve endocarditis due to non-diphtheriae corynebacteria. Of the 52 patients with corynebacterial endocarditis, 11 (21%) had no predisposing conditions and 27 (52%) had structural heart disease; endocarditis in the remaining 14 patients (27%) was associated with noncardiac predisposing factors including injection drug use, chronic hemodialysis, vasculitis, alcoholism, liver transplantation and hemodialysis, a peritoneovenous shunt, and prior aspiration of a noninfected bursa. The mortality rate associated with corynebacterial endocarditis was 31%. The majority of corynebacteria in this series were sensitive to penicillin, erythromycin, gentamicin, and vancomycin. Non-diphtheriae corynebacteria are capable of producing acute valvular damage, even in patients without conditions that are predisposing for endocarditis. The occurrence of bacteremia due to non-diphtheriae corynebacteria in the appropriate clinical setting should alert physicians to the possible diagnosis of endocarditis. Empirical antibiotic therapy with vancomycin, with or without an aminoglycoside, should be initiated pending antibiotic susceptibility testing.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
10/11. Seven patients with respiratory infections due to corynebacterium pseudodiphtheriticum.Seven cases of lower respiratory tract infection due to corynebacterium pseudodiphtheriticum are described. Lower respiratory tract infections with C. pseudodiphtheriticum in immunocompetent patients are usually associated with pre-existing chronic pulmonary disease, and are sometimes associated with endotracheal intubation. Antimicrobial susceptibility testing of these isolates showed uniform sensitivity to penicillin and variable results to erythromycin.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
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