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Lavollay M, Buon C, Le Moigne V, Compain F, Guyonvarch A, Fonvielle M. Exploration of the role of the penicillin binding protein 2c (Pbp2c) in inducible β-lactam resistance in Corynebacteriaceae. Front Microbiol 2024; 15:1327723. [PMID: 38784795 PMCID: PMC11111852 DOI: 10.3389/fmicb.2024.1327723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Six genes encoding putative high molecular weight penicillin-binding proteins (Pbp) are present in the genome of the β-lactam-resistant strain Corynebacterium jeikeium K411. In this study, we show that pbp2c, one of these six genes, is present in resistant strains of Corynebacteriaceae but absent from sensitive strains. The molecular study of the pbp2c locus from C. jeikeium and its heterologous expression in Corynebacterium glutamicum allowed us to show that Pbp2c confers high levels of β-lactam resistance to the host and is under the control of a β-lactam-induced regulatory system encoded by two adjacent genes, jk0410 and jk0411. The detection of this inducible resistance may require up to 48 h of incubation, particularly in Corynebacterium amycolatum. Finally, the Pbp2c-expressing strains studied were resistant to all the β-lactam antibiotics tested, including carbapenems, ceftaroline, and ceftobiprole.
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Affiliation(s)
- Marie Lavollay
- INSERM, Université Paris Cité, Sorbonne Université, Centre de Recherche des Cordeliers, Paris, France
- Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
- Institut Mutualiste Montsouris (IMM), Service de Microbiology, Paris, France
| | - Céline Buon
- INSERM, Université Paris Cité, Sorbonne Université, Centre de Recherche des Cordeliers, Paris, France
| | - Vincent Le Moigne
- Université Paris-Saclay, UVSQ, Inserm, Infection et Inflammation, Montigny-le-Bretonneux, France
| | - Fabrice Compain
- Institut Mutualiste Montsouris (IMM), Service de Microbiology, Paris, France
| | - Armel Guyonvarch
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Matthieu Fonvielle
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Saclay, Gif-sur-Yvette, France
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Kalkinis A, Vassilopoulos G, Rokas S, Koutserimpas C, Samonis G. Contribution of Positron Emission Tomography-Computed Tomography (PET/CT) to the Diagnosis of Endocarditis Due to an Infected Pacemaker Associated With Spondylodiscitis. Cureus 2023; 15:e43140. [PMID: 37692566 PMCID: PMC10484159 DOI: 10.7759/cureus.43140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
The incidence of cardiac device-related endocarditis (CDRIE) is increasing, and its diagnosis and treatment may occasionally be problematic. Echocardiography is important for its diagnosis, and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT) may also be useful as a diagnostic procedure. A case of CDRIE due to an infected pacemaker is presented. In this case, blood cultures were repeatedly negative, and transesophageal ultrasound examination did not reveal signs of the disease. However, PET/CT revealed the infection. The causative organism was Corynebacterium spp, and this was finally identified by polymerase chain reaction of a sample of the device material. Eight weeks before the development of CDRIE symptoms, the patient had been empirically treated for spondylodiscitis caused by a non-identified organism. CDRIE and spondylodiscitis are closely associated infections. The present case of CDRIE was treated successfully with six weeks of combination antimicrobial treatment. PET/CT may contribute to CDRIE diagnosis by locating the site(s) of the infection, especially in cases that are ultrasound and culture negative.
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Affiliation(s)
| | | | - Stelios Rokas
- Department of Cardiology, Metropolitan Hospital, Athens, GRC
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - George Samonis
- Department of Oncology, Metropolitan Hospital, Athens, GRC
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3
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Corynebacterium striatum-Got Worse by a Pandemic? Pathogens 2022; 11:pathogens11060685. [PMID: 35745539 PMCID: PMC9230073 DOI: 10.3390/pathogens11060685] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 02/05/2023] Open
Abstract
The role of Corynebacterium striatum has been demonstrated in different nosocomial infections. An increasing number of publications have demonstrated its virulence in the respiratory tract, especially in the immunosuppressed patient population. The number of these patients has increased significantly during the COVID-19 pandemic. For this reason, we aimed to investigate the prevalence and antimicrobial resistance pattern of this species between 2012 and 2021 at the Clinical Center of the University of Szeged, Hungary. Altogether, 498 positive samples were included from 312 patients during the study period. On the isolates, 4529 antibiotic susceptibility tests were performed. Our data revealed that the prevalence of C. striatum increased during the COVID-19 pandemic, the rise occurred in respiratory, blood culture, and superficial samples. During the study period, the rifampicin resistance significantly increased, but others have also changed dynamically, including linezolid. The species occurred with diverse and changing co-pathogens in the COVID-19 era. However, the increasing rifampicin and linezolid resistance of C. striatum was probably not due to the most commonly isolated co-pathogens. Based on resistance predictions, vancomycin is likely to remain the only effective agent currently in use by 2030.
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Tabaja H, Tai DBG, Beam E, Abdel MP, Tande AJ. Clinical Profile of Monomicrobial Corynebacterium Hip and Knee Periprosthetic Joint Infections. Open Forum Infect Dis 2022; 9:ofac193. [PMID: 35873283 PMCID: PMC9297158 DOI: 10.1093/ofid/ofac193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Corynebacterium periprosthetic joint infection (PJI) is a poorly described infectious syndrome. Prior studies included cases of polymicrobial infections. This series describes the clinical characteristics, management, and outcomes of monomicrobial Corynebacterium PJI. Methods We queried the Mayo Clinic Total Joint Registry for cases of monomicrobial Corynebacterium knee and hip PJI in adults (age ≥18 years) between 2010 and 2019. Results A total of 20 (1%) out of 2067 PJI cases met our inclusion criteria. Most were males (55%), and the median age was 64 years. Seventy percent had chronic symptoms (>4 weeks). PJI was delayed to late (>3 months postimplantation) in 90%. Three species were identified: C. striatum (70%), C. jeikeium (20%), and C. amycolatum (10%). All tested isolates were susceptible to vancomycin (100%) and linezolid (100%), and most had a minimum inhibitory concentration ≤0.06 mcg/mL to daptomycin (75%). Other agents were less reliable, with high resistance to oral agents commonly used for suppression. Nineteen patients were treated: 37% debridement and implant retention (DAIR), 47% 2-stage exchange, and 16% resection without reimplantation. Of these, failure occurred in 29%, 11%, and 0%, respectively. Conclusions Corynebacterium PJIs pose a therapeutic challenge due to limited antimicrobial armamentarium and undefined optimal surgical intervention. Vancomycin and linezolid remain the most reliable agents for treatment. DAIR may be attempted for acute PJI, but verification of durable chronic suppression options will be critical for this approach.
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Affiliation(s)
- Hussam Tabaja
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Don Bambino Geno Tai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elena Beam
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Tande
- Correspondence: Aaron J. Tande, MD, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 ()
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Streifel AC, Varley CD, Ham Y, Sikka MK, Lewis JS. The challenge of antibiotic selection in prosthetic joint infections due to Corynebacterium striatum: a case report. BMC Infect Dis 2022; 22:290. [PMID: 35346085 PMCID: PMC8962155 DOI: 10.1186/s12879-022-07270-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/13/2022] [Indexed: 12/18/2022] Open
Abstract
Background Corynebacterium striatum is a gram-positive facultative anaerobe found in the environment and human flora that has historically been considered a contaminant. More recently, Corynebacterium striatum has been implicated in human infections, including respiratory infections, endocarditis, and bone and joint infections, particularly those involving hardware or implanted devices. Case presentation A 65-year-old man presented for washout of his left total knee arthroplasty following a revision 20 days prior. The patient underwent debridement of his left total knee and revision of the left total femur arthroplasty. Daptomycin was initiated empirically due to a previous rash from vancomycin. Operative tissue cultures grew Staphylococcus haemolyticus, Staphylococcus epidermidis and Corynebacterium striatum. Given concern for daptomycin resistance and the reliability of vancomycin susceptibility, daptomycin was discontinued and vancomycin initiated following a graded challenge. Within a few days, the patient developed a diffuse, blanching, erythematous, maculopapular rash and daptomycin was restarted. Over the next 72 h, his rash progressed and he met criteria for drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Daptomycin was stopped and oral linezolid initiated; rash improved. C. striatum returned with susceptibility to gentamicin, linezolid, vancomycin and daptomycin. Due to concern for adverse effects on long-term linezolid, daptomycin was restarted and was tolerated for 20 days, at which point purulent drainage from incision increased. The patient underwent another arthroplasty revision and washout. Operative cultures from this surgery were again positive for C. striatum. Repeat C. striatum susceptibilities revealed resistance to daptomycin but retained susceptibility to linezolid. Daptomycin was again changed to linezolid. He completed six weeks of linezolid followed by linezolid 600 mg daily for suppression and ultimately opted for disarticulation. Conclusions C. striatum has historically been regarded as a contaminant, particularly when grown in tissue culture in the setting of prosthetic joint infection. Based on the available literature and susceptibility patterns, the most appropriate first-line therapy is vancomycin or linezolid. Treatment with daptomycin should be avoided, even when isolates appear susceptible, due to the risk of development of high-level resistance (MIC > 256 µg/mL) and clinical failure.
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Affiliation(s)
- Amber C Streifel
- Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
| | - Cara D Varley
- Department of Medicine, Division of Infectious Diseases, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,School of Public Health, Oregon Health and Science University-Portland State University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - YoungYoon Ham
- Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Monica K Sikka
- Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - James S Lewis
- Department of Pharmacy, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,Department of Medicine, Division of Infectious Diseases, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
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Leyton B, Ramos JN, Baio PVP, Veras JFC, Souza C, Burkovski A, Mattos-Guaraldi AL, Vieira VV, Abanto Marin M. Treat Me Well or Will Resist: Uptake of Mobile Genetic Elements Determine the Resistome of Corynebacterium striatum. Int J Mol Sci 2021; 22:7499. [PMID: 34299116 PMCID: PMC8304765 DOI: 10.3390/ijms22147499] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022] Open
Abstract
Corynebacterium striatum, a bacterium that is part of the normal skin microbiota, is also an opportunistic pathogen. In recent years, reports of infections and in-hospital and nosocomial outbreaks caused by antimicrobial multidrug-resistant C. striatum strains have been increasing worldwide. However, there are no studies about the genomic determinants related to antimicrobial resistance in C. striatum. This review updates global information related to antimicrobial resistance found in C. striatum and highlights the essential genomic aspects in its persistence and dissemination. The resistome of C. striatum comprises chromosomal and acquired elements. Resistance to fluoroquinolones and daptomycin are due to mutations in chromosomal genes. Conversely, resistance to macrolides, tetracyclines, phenicols, beta-lactams, and aminoglycosides are associated with mobile genomic elements such as plasmids and transposons. The presence and diversity of insertion sequences suggest an essential role in the expression of antimicrobial resistance genes (ARGs) in genomic rearrangements and their potential to transfer these elements to other pathogens. The present study underlines that the resistome of C. striatum is dynamic; it is in evident expansion and could be acting as a reservoir for ARGs.
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Affiliation(s)
- Benjamin Leyton
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile;
- Carrera de Bioquímica, Departamento de Ciencias Químicas y Recursos Naturales, Universidad de La Frontera, Temuco 4811230, Chile
| | - Juliana Nunes Ramos
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-361, Brazil; (J.N.R.); (P.V.P.B.); (J.F.C.V.); (V.V.V.)
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro—LDCIC/FCM/UERJ, Rio de Janeiro 20550-170, Brazil; (C.S.); (A.L.M.-G.)
| | - Paulo Victor Pereira Baio
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-361, Brazil; (J.N.R.); (P.V.P.B.); (J.F.C.V.); (V.V.V.)
| | - João Flávio Carneiro Veras
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-361, Brazil; (J.N.R.); (P.V.P.B.); (J.F.C.V.); (V.V.V.)
| | - Cassius Souza
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro—LDCIC/FCM/UERJ, Rio de Janeiro 20550-170, Brazil; (C.S.); (A.L.M.-G.)
| | - Andreas Burkovski
- Department of Biology, Professur für Mikrobiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Staudtstrasse 5, 91058 Erlangen, Germany;
| | - Ana Luíza Mattos-Guaraldi
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro—LDCIC/FCM/UERJ, Rio de Janeiro 20550-170, Brazil; (C.S.); (A.L.M.-G.)
| | - Verônica Viana Vieira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-361, Brazil; (J.N.R.); (P.V.P.B.); (J.F.C.V.); (V.V.V.)
| | - Michel Abanto Marin
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile;
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Evaluating the Rapid Emergence of Daptomycin Resistance in Corynebacterium: a Multicenter Study. J Clin Microbiol 2021; 59:JCM.02052-20. [PMID: 33472898 DOI: 10.1128/jcm.02052-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
Members of the genus Corynebacterium are increasingly recognized as pathobionts and can be very resistant to antimicrobial agents. Previous studies have demonstrated that Corynebacterium striatum can rapidly develop high-level daptomycin resistance (HLDR) (MIC, ≥256 μg/ml). Here, we conducted a multicenter study to assay for this in vitro phenotype in diverse Corynebacterium species. Corynebacterium clinical isolates (n = 157) from four medical centers were evaluated. MIC values to daptomycin, vancomycin, and telavancin were determined before and after overnight exposure to daptomycin to identify isolates able to rapidly develop daptomycin nonsusceptibility. To investigate assay reproducibility, 18 isolates were evaluated at three study sites. In addition, the stability of daptomycin nonsusceptibility was tested using repeated subculture without selective pressure. The impact of different medium brands was also investigated. Daptomycin nonsusceptibility emerged in 12 of 23 species evaluated in this study (C. afermentans, C. amycolatum, C. aurimucosum, C. bovis, C. jeikeium, C. macginleyi, C. pseudodiphtheriticum, C. resistens, C. simulans, C. striatum, C. tuberculostearicum, and C. ulcerans) and was detected in 50 of 157 (31.8%) isolates tested. All isolates displayed low (susceptible) MIC values to vancomycin and telavancin before and after daptomycin exposure. Repeated subculture demonstrated that 2 of 9 isolates (22.2%) exhibiting HLDR reverted to a susceptible phenotype. Of 30 isolates tested on three medium brands, 13 (43.3%) had differences in daptomycin MIC values between brands. Multiple Corynebacterium species can rapidly develop daptomycin nonsusceptibility, including HLDR, after a short daptomycin exposure period.
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Bläckberg A, Falk L, Oldberg K, Olaison L, Rasmussen M. Infective Endocarditis Due to Corynebacterium Species: Clinical Features and Antibiotic Resistance. Open Forum Infect Dis 2021; 8:ofab055. [PMID: 33738317 PMCID: PMC7953647 DOI: 10.1093/ofid/ofab055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/28/2021] [Indexed: 11/14/2022] Open
Abstract
Background Corynebacterium species are often dismissed as contaminants in blood cultures, but they can also cause infective endocarditis (IE), which is a severe condition. Antibiotic resistance of corynebacteria is increasing making treatment challenging. Reports on IE caused by Corynebacterium species are scarce and more knowledge is needed. Methods Cases of IE caused by Corynebacterium species were identified through the Swedish Registry of Infective Endocarditis. Isolates were collected for species redetermination by matrix-assisted laser desorption ionization-time of flight and for antibiotic susceptibility testing using Etests. Results Thirty episodes of IE due to Corynebacterium species were identified between 2008 and 2017. The median age of patients was 71 years (interquartile range, 60–76) and 77% were male. Corynebacterium striatum (n = 11) was the most common IE causing pathogen followed by Corynebacterium jeikeium (n = 5). Surgery was performed in 50% and in-hospital mortality rate was 13%. Patients with IE caused by Corynebacterium species were significantly more likely to have prosthetic valve endocarditis (70%), compared with patients with IE due to Staphylococcus aureus or non-beta-hemolytic streptococci (14% and 26%, respectively) (P < .0001). Vancomycin was active towards all Corynebacterium isolates, whereas resistance towards penicillin G was common. Conclusions Corynebacterium species cause IE, where prosthetic valves are mainly affected and surgery is often performed. Corynebacterium striatum is an important causative agent of IE within the genus. Antibiotic resistance of corynebacteria is relatively common but resistance towards vancomycin could not be detected in vitro.
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Affiliation(s)
- Anna Bläckberg
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Sweden.,Division of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Linn Falk
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Sweden
| | - Karl Oldberg
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Sweden.,Department of Clinical Microbiology, Region Skåne, Lund, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.,Head of Swedish Registry of Infective Endocarditis, Swedish Society of Infectious Diseases, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Sweden.,Division of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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A case of dyspnea due to pathogenic Corynebacterium striatum in a patient with a bronchial stent. Enferm Infecc Microbiol Clin 2020; 38:197-199. [DOI: 10.1016/j.eimc.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/15/2019] [Accepted: 08/24/2019] [Indexed: 10/25/2022]
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From contamination to infective endocarditis-a population-based retrospective study of Corynebacterium isolated from blood cultures. Eur J Clin Microbiol Infect Dis 2019; 39:113-119. [PMID: 31485919 PMCID: PMC6962118 DOI: 10.1007/s10096-019-03698-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/30/2019] [Indexed: 12/16/2022]
Abstract
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.
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Ramos JN, Souza C, Faria YV, da Silva EC, Veras JFC, Baio PVP, Seabra SH, de Oliveira Moreira L, Hirata Júnior R, Mattos-Guaraldi AL, Vieira VV. Bloodstream and catheter-related infections due to different clones of multidrug-resistant and biofilm producer Corynebacterium striatum. BMC Infect Dis 2019; 19:672. [PMID: 31357945 PMCID: PMC6664767 DOI: 10.1186/s12879-019-4294-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Corynebacterium striatum is an emerging multidrug-resistant (MDR) pathogen associated with immunocompromised and chronically ill patients, as well as nosocomial outbreaks. In this study, we characterized 23 MDR C. striatum isolated of bloodstream and catheter-related infections from a hospital of Rio de Janeiro. METHODS C. striatum isolates were identified by 16S rRNA and rpoB genes sequencing. The dissemination of these isolates was accomplished by pulsed-field gel electrophoresis (PFGE). All isolates were submitted to antimicrobial susceptibility testing by disk diffusion and by minimum inhibitory concentration using E-test strips methods. Antimicrobial resistance genes were detected by polymerase chain reaction. Quantitative tests were performed on four different abiotic surfaces and the ability to produce biofilm on the surface of polyurethane and silicone catheter was also demonstrated by scanning electron microscopy. RESULTS Eleven PFGE profiles were found. The PFGE profile I was the most frequently observed among isolates. Five different MDR profiles were found and all PFGE profile I isolates presented susceptibility only to tetracycline, vancomycin, linezolid and daptomycin. Only the multidrug-susceptible isolate did not show mutations in the quinolone-resistance determinant region (QRDR) of the gyrA gene and was negative in the search of genes encoding antibiotic resistance. The other 22 isolates were positive to resistance genes to aminoglycoside, macrolides/lincosamides and chloramphenicol and showed mutations in the QRDR of the gyrA gene. Scanning electron microscopy illustrated the ability of MDR blood isolate partaker of the epidemic clone (PFGE profile I) to produce mature biofilm on the surface of polyurethane and silicone catheter. CONCLUSIONS Genotyping analysis by PFGE revealed the permanence of the MDR PFGE profile I in the nosocomial environment. Other new PFGE profiles emerged as etiologic agents of invasive infections. However, the MDR PFGE profile I was also found predominant among patients with hematogenic infections. The high level of multidrug resistance associated with biofilm formation capacity observed in MDR C. striatum is a case of concern.
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Affiliation(s)
- Juliana Nunes Ramos
- Laboratório de Difteria e Corinebactérias de Importância Clínica, Faculdade de Ciências Médicas, Centro Colaborador e Referência para pesquisa de Difteria/Ministério da Saúde, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Instituto Nacional de Controle de Qualidade em Saúde, Fundação Oswaldo Cruz, INCQS/FIOCRUZ, Rio de Janeiro, Brazil
- Laboratório Interdisciplinar de Pesquisas Médicas (LIPMED), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Av. Brasil, 4365, Pavilhão Cardoso Fontes, 10 andar, sala 17, Manguinhos, Rio de Janeiro, 21040-900 Brazil
| | - Cassius Souza
- Laboratório de Difteria e Corinebactérias de Importância Clínica, Faculdade de Ciências Médicas, Centro Colaborador e Referência para pesquisa de Difteria/Ministério da Saúde, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Yuri Vieira Faria
- Laboratório de Difteria e Corinebactérias de Importância Clínica, Faculdade de Ciências Médicas, Centro Colaborador e Referência para pesquisa de Difteria/Ministério da Saúde, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Laboratório de Tecnologia em Bioquímica e Microscopia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, Brazil
| | - Eliane Cristine da Silva
- Laboratório de Difteria e Corinebactérias de Importância Clínica, Faculdade de Ciências Médicas, Centro Colaborador e Referência para pesquisa de Difteria/Ministério da Saúde, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - João Flávio Carneiro Veras
- Instituto Nacional de Controle de Qualidade em Saúde, Fundação Oswaldo Cruz, INCQS/FIOCRUZ, Rio de Janeiro, Brazil
| | - Paulo Victor Pereira Baio
- Laboratório de Difteria e Corinebactérias de Importância Clínica, Faculdade de Ciências Médicas, Centro Colaborador e Referência para pesquisa de Difteria/Ministério da Saúde, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Laboratório Interdisciplinar de Pesquisas Médicas (LIPMED), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Av. Brasil, 4365, Pavilhão Cardoso Fontes, 10 andar, sala 17, Manguinhos, Rio de Janeiro, 21040-900 Brazil
| | - Sérgio Henrique Seabra
- Laboratório de Tecnologia em Bioquímica e Microscopia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, Brazil
| | - Lilian de Oliveira Moreira
- Laboratório de Bacteriologia e Imunologia Clínica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raphael Hirata Júnior
- Laboratório de Difteria e Corinebactérias de Importância Clínica, Faculdade de Ciências Médicas, Centro Colaborador e Referência para pesquisa de Difteria/Ministério da Saúde, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Ana Luíza Mattos-Guaraldi
- Laboratório de Difteria e Corinebactérias de Importância Clínica, Faculdade de Ciências Médicas, Centro Colaborador e Referência para pesquisa de Difteria/Ministério da Saúde, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Verônica Viana Vieira
- Laboratório Interdisciplinar de Pesquisas Médicas (LIPMED), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Av. Brasil, 4365, Pavilhão Cardoso Fontes, 10 andar, sala 17, Manguinhos, Rio de Janeiro, 21040-900 Brazil
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Hagiya H, Kimura K, Okuno H, Hamaguchi S, Morii D, Yoshida H, Mitsui T, Nishi I, Tomono K. Bacteremia due to high-level daptomycin-resistant Corynebacterium striatum: A case report with genetic investigation. J Infect Chemother 2019; 25:906-908. [PMID: 31101531 DOI: 10.1016/j.jiac.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 11/17/2022]
Abstract
Corynebacterium striatum, generally considered an opportunistic organism in humans, has recently been known to develop high-level daptomycin resistance (HLDR) shortly after drug exposure. To date, however, only several such clinical isolates have been described in the literature and clinical background of the resistant pathogen remains to be elucidated. Here, we report a case involving a C. striatum strain with HLDR harboring novel nucleotide mutations, together with a review of the relevant literature. To the best of our knowledge, this is the first well-investigated clinical report from Japan including a genetic investigation. Considering the rapid emergence of HLDR C. striatum in vitro experiment, there could be a number of underreporting cases. Scrupulous attention is required when administering daptomycin for the treatment of C. striatum infections, even if the organism has initially exhibited susceptibility.
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Affiliation(s)
- Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Japan.
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Hideo Okuno
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Shigeto Hamaguchi
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Daiichi Morii
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Tomomi Mitsui
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Isao Nishi
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
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13
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Monomicrobial bone and joint infection due to Corynebacterium striatum: literature review and amoxicillin-rifampin combination as treatment perspective. Eur J Clin Microbiol Infect Dis 2019; 38:1269-1278. [PMID: 30903537 DOI: 10.1007/s10096-019-03542-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/14/2019] [Indexed: 12/18/2022]
Abstract
Corynebacterium striatum is a ubiquitous colonizer of human skin and mucous membranes. It is increasingly involved in infections, especially with prosthetic devices or in immunocompromised individuals. Microbiological diagnosis is challenging and bacterial resistance is a major concern. We performed a retrospective study of monomicrobial bone and joint infections (BJI) due to C. striatum in two referral centers from April 2012 to July 2017. We collected the patients' clinical and microbiological characteristics and outcomes. We also performed a literature review of BJI due to C. striatum. We identified 12 cases (nine prosthetic joint infections, one osteosynthetic device infection, one non-union, and one arthritis) in 11 patients, five of which were immunocompromised. Microbiological diagnosis was performed with prolonged culture media. Ten out of 12 strains were susceptible to aminopenicillin, a drug class not recommended for testing by the EUCAST/CASFM guidelines, and 8/12 patients were treated with amoxicillin-rifampicin. The cure rate was 8/12, after a median follow-up period of 487.5 days (IQR 140.3-1348.5). Twelve cases of BJI due to C. striatum were previously reported. Among them, 5/12 patients were immunocompromised, 3/12 cases were acute BJI, and 2/12 were device-related infections. The diagnosis was performed by PCR in one case, and 10/12 patients were treated with glycolipopeptides, with a cure rate of 11/12. We report the largest cohort of monomicrobial BJI with C. striatum. Determination of aminopenicillin susceptibility is essential since it is frequently active in our experience, even in BJI. The cure rate of this infection seems high.
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14
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Abstract
Daptomycin, a last-line-of-defense antibiotic for treating Gram-positive infections, is experiencing clinical failure against important infectious agents, including Corynebacterium striatum The recent transition of daptomycin to generic status is projected to dramatically increase availability, use, and clinical failure. Here we confirm the genetic mechanism of high-level daptomycin resistance (HLDR; MIC = >256 µg/ml) in C. striatum, which evolved within a patient during daptomycin therapy, a phenotype recapitulated in vitro In all 8 independent cases tested, loss-of-function mutations in phosphatidylglycerol synthase (pgsA2) were necessary and sufficient for high-level daptomycin resistance. Through lipidomic and biochemical analysis, we demonstrate that daptomycin's activity is dependent on the membrane phosphatidylglycerol (PG) concentration. Until now, the verification of PG as the in vivo target of daptomycin has proven difficult since tested cell model systems were not viable without membrane PG. C. striatum becomes daptomycin resistant at a high level by removing PG from the membrane and changing the membrane composition to maintain viability. This work demonstrates that loss-of-function mutation in pgsA2 and the loss of membrane PG are necessary and sufficient to produce high-level resistance to daptomycin in C. striatumIMPORTANCE Antimicrobial resistance threatens the efficacy of antimicrobial treatment options, including last-line-of-defense drugs. Understanding how this resistance develops can help direct antimicrobial stewardship efforts and is critical to designing the next generation of antimicrobial therapies. Here we determine how Corynebacterium striatum, a skin commensal and opportunistic pathogen, evolved high-level resistance to a drug of last resort, daptomycin. Through a single mutation, this pathogen was able to remove the daptomycin's target, phosphatidylglycerol (PG), from the membrane and evade daptomycin's bactericidal activity. We found that additional compensatory changes were not necessary to support the removal of PG and replacement with phosphatidylinositol (PI). The ease with which C. striatum evolved high-level resistance is cause for alarm and highlights the importance of screening new antimicrobials against a wide range of clinical pathogens which may harbor unique capacities for resistance evolution.
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15
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Kang SJ, Choi SM, Choi JA, Choi JU, Oh TH, Kim SE, Kim UJ, Won EJ, Jang HC, Park KH, Shin JH, Kweon SS, Jung SI. Factors affecting the clinical relevance of Corynebacterium striatum isolated from blood cultures. PLoS One 2018; 13:e0199454. [PMID: 29928059 PMCID: PMC6013186 DOI: 10.1371/journal.pone.0199454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/07/2018] [Indexed: 02/07/2023] Open
Abstract
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. striatum by matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing were assessed. More than two blood cultures were positive in 25 (48.1%) patients. Diabetes, solid tumor, and a history of previous exposure to antibiotics were more common in patients with multiple positive blood cultures. Charlson comorbidity scores were also higher, and more isolates were recovered after 48 hours of hospital stay in patients with multiple positive blood cultures. Strains recovered from patients with multiple positive blood cultures produced significantly more biofilm. Based on multilocus sequence typing (MLST), sequence type (ST) 20 (31.3%) was the most dominant, followed by ST2 (20.3%) and ST23 (10.9%). There was no relationship between the number of positive blood culture sets and sequence typing. In multivariate analyses, Carlson comorbidity score (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.09–3.36; P = 0.03) and biofilm formation were associated with multiple positive blood cultures (OR, 17.43; 95% CI, 3.71–81.91; P = 0.03). This study provides evidence that the biofilm phenotype could contribute to determining the clinical significance of C. striatum in patients with severe underlying conditions. The predominance of certain STs suggests the relatedness of C. striatum infection and the nosocomial environment.
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Affiliation(s)
- Seung Ji Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Su-Mi Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jin-A Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jin Un Choi
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Tae-Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Uh Jin Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Eun Jeong Won
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee-Chang Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyung-Hwa Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Sook-In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
- * E-mail:
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In Vitro Antibiotic Susceptibility Pattern of Non-diphtheriae Corynebacterium Isolates in Ontario, Canada, from 2011 to 2016. Antimicrob Agents Chemother 2018; 62:AAC.01776-17. [PMID: 29339389 DOI: 10.1128/aac.01776-17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/04/2018] [Indexed: 12/15/2022] Open
Abstract
Non-diphtheriae Corynebacterium-associated disease has been increasingly observed and often presents a conundrum to the treating physician. Analysis of antibiotic susceptibility testing data for 1,970 clinical Corynebacterium isolates received between 2011 and 2016 revealed that empirical drug treatment options are limited to vancomycin and linezolid. Corynebacterium striatum was the most frequently observed species during this study period, along with C. amycolatum and C. pseudodiphtheriticum/C. propinquum Low levels of susceptibility to penicillin (14.5%), erythromycin (15.1%), and clindamycin (8.7%) were observed for non-diphtheriae Corynebacterium species, while 3.0% of isolates were not susceptible to daptomycin. Similarly, 26.9% and 38.1% of Corynebacterium isolates were susceptible to ciprofloxacin and trimethoprim-sulfamethoxazole, respectively. Our data show much lower susceptibility to penicillin than previously reported in the literature and an increasing number of isolates resistant to daptomycin, highlighting the need for continued antibiotic surveillance studies for appropriate patient management and treatment success.
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Hahn WO, Werth BJ, Butler-Wu SM, Rakita RM. Multidrug-Resistant Corynebacterium striatum Associated with Increased Use of Parenteral Antimicrobial Drugs. Emerg Infect Dis 2018; 22. [PMID: 27767926 PMCID: PMC5088002 DOI: 10.3201/eid2211.160141] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Device-related infections with this pathogen frequently require prolonged parenteral therapy. Corynebacterium striatum is an emerging multidrug-resistant bacteria. We retrospectively identified 179 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. striatum infections were matched with patients infected with coagulase-negative staphylococci for case–control analysis. A total of 87 (71%) of 121 isolates were resistant to all oral antimicrobial drugs tested, including penicillin, tetracycline, clindamycin, erythromycin, and ciprofloxacin. When isolated from hardware or devices, C. striatum was pathogenic in 38 (87%) of 44 cases. Patients with hardware-associated C. striatum infections received parenteral antimicrobial drugs longer than patients with hardware-associated coagulase-negative staphylococci infections (mean ± SD 69 ± 5 days vs. 25 ± 4 days; p<0.001). C. striatum commonly shows resistance to antimicrobial drugs with oral bioavailability and is associated with increased use of parenteral antimicrobial drugs.
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18
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When Good Bugs Go Bad: Epidemiology and Antimicrobial Resistance Profiles of Corynebacterium striatum, an Emerging Multidrug-Resistant, Opportunistic Pathogen. Antimicrob Agents Chemother 2017; 61:AAC.01111-17. [PMID: 28848008 DOI: 10.1128/aac.01111-17] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/09/2017] [Indexed: 01/11/2023] Open
Abstract
Infections with Corynebacterium striatum have been described in the literature over the last 2 decades, with the majority being bacteremia, central line infections, and occasionally, endocarditis. In recent years, the frequency of C. striatum infections appears to be increasing; a factor likely contributing to this is the increased ease and accuracy of the identification of Corynebacterium spp., including C. striatum, from clinical cultures. The objective of this study was to retrospectively characterize C. striatum isolates recovered from specimens submitted as part of routine patient care at a 1,250-bed, tertiary-care academic medical center. Multiple strain types were recovered, as demonstrated by repetitive-sequence-based PCR. Most of the strains of C. striatum characterized were resistant to antimicrobials commonly used to treat Gram-positive organisms, such as penicillin, ceftriaxone, meropenem, clindamycin, and tetracycline. The MIC50 for ceftaroline was >32 μg/ml. Although there are no interpretive criteria for susceptibility with telavancin, it appeared to have potent in vitro efficacy against this species, with MIC50 and MIC90 values of 0.064 and 0.125 μg/ml, respectively. Finally, as previously reported in case studies, we demonstrated rapid in vitro development of daptomycin resistance in 100% of the isolates tested (n = 50), indicating that caution should be exhibited when using daptomycin for the treatment of C. striatum infections. C. striatum is an emerging, multidrug-resistant pathogen that can be associated with a variety of infection types.
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Alibi S, Ferjani A, Boukadida J, Cano ME, Fernández-Martínez M, Martínez-Martínez L, Navas J. Occurrence of Corynebacterium striatum as an emerging antibiotic-resistant nosocomial pathogen in a Tunisian hospital. Sci Rep 2017; 7:9704. [PMID: 28848236 PMCID: PMC5573724 DOI: 10.1038/s41598-017-10081-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/04/2017] [Indexed: 11/17/2022] Open
Abstract
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. striatum isolated at the Farhat-Hached hospital, Sousse (Tunisia), during the period 2011–2014, to a panel of 16 compounds belonging to the main clinically relevant classes of antimicrobial agents. All strains were susceptible to vancomycin, linezolid, and daptomycin. Amikacin and gentamicin also showed good activity (MICs90 = 1 and 2 mg/L, respectively). High rates of resistance to penicillin (82.5%), clindamycin (79.4%), cefotaxime (60.3%), erythromycin (47.6%), ciprofloxacin (36.5%), moxifloxacin (34.9%), and rifampicin (25.4%) were observed. Fifty-nine (93.7%) out of the 63 isolates showed resistance to at least one compound and 31 (49.2%) were multidrug-resistant. Twenty-nine resistance profiles were distinguished among the 59 resistant C. striatum. Most of the strains resistant to fluoroquinolones showed a double mutation leading to an amino acid change in positions 87 and 91 in the quinolone resistance-determining region of the gyrA gene. The 52 strains resistant to penicillin were positive for the gene bla, encoding a class A β-lactamase. Twenty-two PFGE patterns were identified among the 63 C. striatum, indicating that some clones have spread within the hospital.
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Affiliation(s)
- Sana Alibi
- Laboratoire de microbiologie-immunologie, unite de recherché "caractérisation génomique des agents infectieux UR12SP34", CHU Farhat-Hached, Sousse, Tunisia.,Faculté des sciences de Bizerte, Université de Carthage, Jarzouna, Tunisia
| | - Asma Ferjani
- Laboratoire de microbiologie-immunologie, unite de recherché "caractérisation génomique des agents infectieux UR12SP34", CHU Farhat-Hached, Sousse, Tunisia
| | - Jalel Boukadida
- Laboratoire de microbiologie-immunologie, unite de recherché "caractérisation génomique des agents infectieux UR12SP34", CHU Farhat-Hached, Sousse, Tunisia
| | - María Eliecer Cano
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Marta Fernández-Martínez
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Luis Martínez-Martínez
- Unidad de Gestión Clínica, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Microbiología, Universidad de Córdoba, Córdoba, Spain
| | - Jesús Navas
- Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain.
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20
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Development of High-Grade Daptomycin Resistance in a Patient Being Treated for Corynebacterium striatum Infection. Antimicrob Agents Chemother 2017; 61:AAC.00705-17. [PMID: 28483949 DOI: 10.1128/aac.00705-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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D'Arezzo S, Mazzarelli A, Venditti C, Nisii C, Petrosillo N, De Giuli C, Vulcano A, Paglia MG, Bordi E, Di Caro A, Taglietti F. Ceftaroline Plus Ampicillin Against Gram-Positive Organisms: Results from E-Test Synergy Assays. Microb Drug Resist 2017; 23:507-515. [PMID: 27526275 DOI: 10.1089/mdr.2016.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In an era of increasing drug resistance and limited numbers of antimicrobials in the drug production pipeline, healthcare-associated infections represent a growing public health threat. When therapeutic options are limited, clinicians often resort to using antimicrobial combinations that produce a synergistic effect on the target pathogen. Novel antibiotics are therefore welcome in the daily practice of medicine. For example, ceftaroline is a broad-spectrum cephalosporin active against a variety of bacteria, including methicillin-resistant Staphylococcus aureus, but with limited activity against enterococci, particularly Enterococcus faecium. In this study, we tested the efficacy of ceftaroline against clinical isolates of gram-positive bacteria (S. aureus, Enterococcus faecalis, and E. faecium) by the broth microdilution and E-test assays, and then evaluated the synergistic effect of ceftaroline and ampicillin using the E-test method. The time-kill assay was used to confirm the data on selected strains. This drug combination has been recently shown to be effective against E. faecalis and could offer the advantage of cost-effectiveness (compared to other synergistic associations) as well as good tolerability. The E-test was chosen because of its relative simplicity of use that makes it suitable for routine clinical laboratories as a quick tool to guide clinicians when confronted with difficult-to-treat infections that may require an empirical approach. Our results indicate the presence of a synergistic effect of ceftaroline and ampicillin on most of the strains used, especially E. faecium and E. faecalis. The fact that two of those Enterococcus strains were vancomycin resistant suggests that the possible use of this combination for combating the spread of vancomycin-resistant enterococci should be explored.
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Affiliation(s)
- Silvia D'Arezzo
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Antonio Mazzarelli
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Carolina Venditti
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Carla Nisii
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Nicola Petrosillo
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Chiara De Giuli
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Antonella Vulcano
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Maria Grazia Paglia
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Eugenio Bordi
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Antonino Di Caro
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
| | - Fabrizio Taglietti
- "Lazzaro Spallanzani" National Institute for Infectious Diseases IRCCS , Rome, Italy
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22
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Werth BJ, Hahn WO, Butler-Wu SM, Rakita RM. Emergence of High-Level Daptomycin Resistance in Corynebacterium striatum in Two Patients with Left Ventricular Assist Device Infections. Microb Drug Resist 2015; 22:233-7. [PMID: 26544621 DOI: 10.1089/mdr.2015.0208] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION We describe the clinical and microbiologic courses of two patients with ventricular assist device infections secondary to Corynebacterium striatum treated with daptomycin. In both cases, the pathogen was initially susceptible to daptomycin (minimum inhibitory concentration [MIC] <0.125 mg/L) but became resistant (MIC >256 mg/L) during therapy. METHODS The clonal nature of the isolates was determined by pulse-field gel electrophoresis (PFGE). Daptomycin binding was assessed by fluorescence microscopy using daptomycin-boron-dipyrromethene (bodipy). Induction and stability of daptomycin resistance were assessed by culturing strains in the presence of low concentrations of daptomycin or passage of resistant strains on daptomycin-free medium and repeat MIC testing, respectively. RESULTS PFGE revealed that resistant clinical isolates were genetically indistinguishable from their parent strains, but the two pairs were unrelated to each other. The resistant strains had 7.5-15 times lower binding of daptomycin-bodipy compared to the related susceptible strains (p ≤ 0.0002). High-level daptomycin resistance (MIC >256 mg/L) was generated in vitro for both susceptible parent strains after overnight culture in the presence of daptomycin. One of the resistant strains maintained a high-level resistance phenotype up to 5 days of passage on daptomycin-free medium, whereas the other strain reverted back to a susceptible phenotype (MIC = 0.38 mg/L) after one passage on daptomycin-free medium, with a concomitant increase in daptomycin binding. CONCLUSIONS High-level daptomycin resistance in C. striatum was readily generated in vitro and during the course of therapy in these patients. This resistance appears to be mediated by reduced daptomycin binding. Providers should be cautious about using long-term daptomycin monotherapy for C. striatum infections.
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Affiliation(s)
- Brian J Werth
- 1 School of Pharmacy, University of Washington , Seattle, Washington
| | - William O Hahn
- 2 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington , Seattle, Washington
| | - Susan M Butler-Wu
- 3 Department of Laboratory Medicine, University of Washington , Seattle, Washington
| | - Robert M Rakita
- 2 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington , Seattle, Washington
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23
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Abstract
Daptomycin (DAP) is a cyclic lipopeptide with in vitro activity against a variety of Gram-positive pathogens, including multidrug-resistant organisms. Since its introduction into clinical practice in 2003, DAP has become an important key frontline antibiotic for severe or deep-seated infections caused by Gram-positive organisms. Unfortunately, DAP resistance (DAP-R) has been extensively documented in clinically important organisms such as Staphylococcus aureus, Enterococcus spp., and Streptococcus spp. Studies on the mechanisms of DAP-R in Bacillus subtilis and other Gram-positive bacteria indicate that the genetic pathways of DAP-R are diverse and complex. However, a common phenomenon emerging from these mechanistic studies is that DAP-R is associated with important adaptive changes in cell wall and cell membrane homeostasis with critical changes in cell physiology. Findings related to these adaptive changes have provided novel insights into the genetics and molecular mechanisms of bacterial cell envelope stress response and the manner in which Gram-positive bacteria cope with the antimicrobial peptide attack and protect vital structures of the cell envelope, such as the cell membrane. In this review, we will examine the most recent findings related to the molecular mechanisms of resistance to DAP in relevant Gram-positive pathogens and discuss the clinical implications for therapy against these important bacteria.
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Affiliation(s)
- Truc T Tran
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.,International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Jose M Munita
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.,International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Cesar A Arias
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.,International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, Houston, Texas.,Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogota, Colombia
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Penchovsky R, Traykovska M. Designing drugs that overcome antibacterial resistance: where do we stand and what should we do? Expert Opin Drug Discov 2015; 10:631-50. [PMID: 25981754 DOI: 10.1517/17460441.2015.1048219] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION In recent years, infections caused by multidrug-resistant bacterial pathogens have become a huge issue to public healthcare systems. Indeed, the misuse of antibiotics has led to, over the past 30 years, the emergence of a number of resistant bacterial strains including Staphylococcus aureus, Neisseria gonorrhoeae, Escherichia coli and Mycobacterium tuberculosis. Unfortunately, efforts to produce new antibiotics have not been sufficient to cope with the emergence of these new antibiotic-resistant (AR) strains. AREAS COVERED There is an urgent need to invent and employ unconventional strategies for antimicrobial drug development to tackle the rising global threats imposed by the spread of antimicrobial resistance. Herein, the authors discuss these novel design strategies and provide their expert perspective on the subject. EXPERT OPINION To deal with the growing threat of AR, it is important to cut down the use of antibiotics to the very minimum to diminish the risk of unknown drug-resistant bacteria and increase antibacterial vaccination programs. Furthermore, it is important to develop new classes of antibiotics that can deal with multidrug-resistant bacterial pathogens.
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Affiliation(s)
- Robert Penchovsky
- Sofia University "St. Kliment Ohridski", Department of Genetics, Faculty of Biology , 8 Dragan Tzankov Blvd., 1164 Sofia , Bulgaria +35928167340 ; +35928167340 ;
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