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Bermejo Olano MDM, Campelo Gutierrez C, Hervas Gómez R, Alfayate García JM, Sánchez Ríos JP, Moreno Núñez L. [Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot]. Med Clin (Barc) 2024; 162:15-18. [PMID: 37981483 DOI: 10.1016/j.medcli.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. METHODS A case-control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. RESULTS Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). CONCLUSIONS Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot.
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Affiliation(s)
| | | | - Rafael Hervas Gómez
- Unidad de Infecciosas, Hospital Universitario Fundación Alcorcón, Madrid, España
| | | | | | - Leonor Moreno Núñez
- Unidad de Infecciosas, Hospital Universitario Fundación Alcorcón, Madrid, España.
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2
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Kang Y, Chen S, Zheng B, Du X, Li Z, Tan Z, Zhou H, Huang J, Tian L, Zhong J, Ma X, Li F, Yao J, Wang Y, Zheng M, Li Z. Epidemiological Investigation of Hospital Transmission of Corynebacterium striatum Infection by Core Genome Multilocus Sequence Typing Approach. Microbiol Spectr 2023; 11:e0149022. [PMID: 36537812 PMCID: PMC9927548 DOI: 10.1128/spectrum.01490-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Corynebacterium striatum has recently received increasing attention due to its multiple antimicrobial resistances and its role as an invasive infection/outbreak agent. Recently, whole-genome sequencing (WGS)-based core genome multilocus sequence typing (cgMLST) has been used in epidemiological studies of specific human pathogens. However, this method has not been reported in studies of C. striatum. In this work, we aim to propose a cgMLST scheme for C. striatum. All publicly available C. striatum genomes, 30 C. striatum strains isolated from the same hospital, and 1 epidemiologically unrelated outgroup C. striatum strain were used to establish a cgMLST scheme targeting 1,795 genes (hereinafter referred to as 1,795-cgMLST). The genotyping results of cgMLST showed good congruence with core genome-based single-nucleotide polymorphism typing in terms of tree topology. In addition, the cgMLST provided a greater discrimination than the MLST method based on 6 housekeeping genes (gyrA, gyrB, hsp65, rpoB, secA1, and sodA). We established a clonal group (CG) threshold based on 104 allelic differences; a total of 56 CGs were identified from among 263 C. striatum strains. We also defined an outbreak threshold based on seven allelic differences that is capable of identifying closely related isolates that could give clues on hospital transmission. According to the results of analysis of drug-resistant genes and virulence genes, we identified CG4, CG5, CG26, CG28, and CG55 as potentially hypervirulent and multidrug-resistant CGs of C. striatum. This study provides valuable genomic epidemiological data on the diversity, resistance, and virulence profiles of this potentially pathogenic microorganism. IMPORTANCE Recently, WGS of many human and animal pathogens has been successfully used to investigate microbial outbreaks. The cgMLST schema are powerful genotyping tools that can be used to investigate potential epidemics and provide classification of the strains precise and reliable. In this study, we proposed the development of a cgMLST typing scheme for C. striatum, and then we evaluated this scheme for its applicability to hospital transmission investigations. This report describes the first cgMLST schema for C. striatum. The analysis of hospital transmission of C. striatum based on cgMLST methods has important clinical epidemiological significance for improving nosocomial infection monitoring of C. striatum and in-depth understanding of its nosocomial transmission routes.
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Affiliation(s)
- Yutong Kang
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shenglin Chen
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Beijia Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Clinical Laboratory, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Xiaoli Du
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenpeng Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhizhou Tan
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jia Huang
- Institute for the Prevention and Control of Infectious Diseases, Xinjiang Center for Disease Control and Prevention, Urumqi, Xinjiang, China
| | - Leihao Tian
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jiaxin Zhong
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xueli Ma
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Fang Li
- Department of Medicine, Tibet University, Lhasa, Tibet, China
| | - Jiang Yao
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Wang
- Department of Clinical Laboratory Medicine, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Meiqin Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Zhenjun Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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3
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Zhang H, Tan X, Zhang Z, Yang X, Wang L, Li M, Shi D, Li Y, Li J, Li Z, Liao X. Targeted Antibiotics for Lower Respiratory Tract Infection with Corynebacterium striatum. Infect Drug Resist 2023; 16:2019-2028. [PMID: 37038476 PMCID: PMC10082571 DOI: 10.2147/idr.s404855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023] Open
Abstract
Purpose To assess the impact of targeted antibiotic therapy on clinical outcomes of patients with lower respiratory tract (LRT) infection with Corynebacterium striatum (C. striatum). Methods A new propensity score-inverse probability of treatment weighting (IPTW) cohort study was conducted by using 10-year data. The study included LRT infection patients with respiratory secretions cultured positive for C. striatum simultaneously. The primary outcome was all-cause hospital mortality; the secondary outcomes included hospital stay, ICU stay and ventilation time. The safety outcomes were drug-related serum creatinine (Cr) increase and thrombocytopenia. Results A total of 339 patients were included in the cohort, and 84 (24.78%) initiated vancomycin or linezolid therapy. In the new IPTW cohort, targeted antibiotic therapy did not improve all-cause hospital mortality (P=0.632), and the OR (95% CI) was 0.879 (0.519-1.488). Moreover, targeted antibiotic therapy was not associated with hospital stay (P=0.415), ICU stay (P=0.945) or ventilation time (P=0.885). The side effects of drug-related higher serum Cr (P=0.044) and thrombocytopenic levels (P=0.038) cannot be ignored. Conclusion Clinical benefits by vancomycin or linezolid targeted against LRT infection with C. striatum were limited and with drug-related side effects. A prospectively designed study is needed to further confirm the results.
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Affiliation(s)
- Huan Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Department of Critical Care Medicine, The Third People’s Hospital of Chengdu, Chengdu, People’s Republic of China
| | - Xiaojiao Tan
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Zhen Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xuewei Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Lijie Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Meiqian Li
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Dan Shi
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yao Li
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jianbo Li
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Zhen Li
- Clinical Research Unit, First Maternity and Infant Hospital of Shanghai, Shanghai, People’s Republic of China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Department of Critical Care Medicine, West China Tianfu Hospital of Sichuan University, Chengdu, People’s Republic of China
- Correspondence: Xuelian Liao, Department of Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou district, Chengdu, People’s Republic of China, Tel +8613541023033, Email
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4
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Jesus HNR, Ramos JN, Rocha DJPG, Alves DA, Silva CS, Cruz JVO, Vieira VV, Souza C, Santos LS, Navas J, Ramos RTJ, Azevedo V, Aguiar ERGR, Mattos-Guaraldi AL, Pacheco LGC. The pan-genome of the emerging multidrug-resistant pathogen Corynebacterium striatum. Funct Integr Genomics 2022; 23:5. [PMID: 36534203 DOI: 10.1007/s10142-022-00932-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/06/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Corynebacterium striatum, a common constituent of the human skin microbiome, is now considered an emerging multidrug-resistant pathogen of immunocompromised and chronically ill patients. However, little is known about the molecular mechanisms in the transition from colonization to the multidrug-resistant (MDR) invasive phenotype in clinical isolates. This study performed a comprehensive pan-genomic analysis of C. striatum, including isolates from "normal skin microbiome" and from MDR infections, to gain insights into genetic factors contributing to pathogenicity and multidrug resistance in this species. For this, three novel genome sequences were obtained from clinical isolates of C. striatum of patients from Brazil, and other 24 complete or draft C. striatum genomes were retrieved from GenBank, including the ATCC6940 isolate from the Human Microbiome Project. Analysis of C. striatum strains demonstrated the presence of an open pan-genome (α = 0.852803) containing 3816 gene families, including 15 antimicrobial resistance (AMR) genes and 32 putative virulence factors. The core and accessory genomes included 1297 and 1307 genes, respectively. The identified AMR genes are primarily associated with resistance to aminoglycosides and tetracyclines. Of these, 66.6% are present in genomic islands, and four AMR genes, including aac(6')-ib7, are located in a class 1-integron. In conclusion, our data indicated that C. striatum possesses genomic characteristics favorable to the invasive phenotype, with high genomic plasticity, a robust genetic arsenal for iron acquisition, and important virulence determinants and AMR genes present in mobile genetic elements.
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Affiliation(s)
- Hendor N R Jesus
- Multicenter Post-Graduate Program in Biochemistry and Molecular Biology (PMBqBM), Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - Juliana N Ramos
- Laboratory of Diphtheria and Corinebacteria of Clinical Relevance, School of Medical Sciences, Rio de Janeiro State University - LDCIC/FCM/UERJ, Rio de Janeiro, RJ, Brazil
| | - Danilo J P G Rocha
- Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - Daniele A Alves
- Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil.,Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina S Silva
- Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - João V O Cruz
- Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - Verônica V Vieira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Rio de Janeiro, RJ, Brazil
| | - Cassius Souza
- Laboratory of Diphtheria and Corinebacteria of Clinical Relevance, School of Medical Sciences, Rio de Janeiro State University - LDCIC/FCM/UERJ, Rio de Janeiro, RJ, Brazil
| | - Louisy S Santos
- Laboratory of Diphtheria and Corinebacteria of Clinical Relevance, School of Medical Sciences, Rio de Janeiro State University - LDCIC/FCM/UERJ, Rio de Janeiro, RJ, Brazil
| | - Jesus Navas
- Cantabria University, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Rommel T J Ramos
- Institute of Biological Sciences, Federal University of Para, Belem, PA, Brazil.,Biological Engineering Laboratory, Science and Technology Park Guama, Belem, PA, Brazil
| | - Vasco Azevedo
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Eric R G R Aguiar
- Department of Biological Sciences, State University of Santa Cruz, Ilhéus, BA, Brazil
| | - Ana L Mattos-Guaraldi
- Laboratory of Diphtheria and Corinebacteria of Clinical Relevance, School of Medical Sciences, Rio de Janeiro State University - LDCIC/FCM/UERJ, Rio de Janeiro, RJ, Brazil
| | - Luis G C Pacheco
- Multicenter Post-Graduate Program in Biochemistry and Molecular Biology (PMBqBM), Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil. .,Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil.
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5
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Wang J, Pei J, Liu M, Huang R, Li J, Liao S, Liang J. Identification and Evolutionary Relationship of Corynebacterium striatum Clinical Isolates. Pathogens 2022; 11:pathogens11091012. [PMID: 36145444 PMCID: PMC9501166 DOI: 10.3390/pathogens11091012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/27/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Corynebacterium striatum has developed into a new community-acquired and hospital-acquired multi-drug resistance (MDR) bacterium, and is a potential target pathogen for infection control and antibacterial management projects. In this study, non-duplicate samples of inpatients were collected from a local central hospital. Mass spectrometry showed that 54 C. striatum isolates mainly appeared in secretion and sputum from 14 departments. Protein fingerprint cluster analysis showed that the isolates were divided into four groups, most of which appeared in summer. The drug resistance test showed that all strains had multi-drug resistance, with high resistance rates to lincosamides, quinolones and tetracycline detected. Further analysis of the phylogenetic tree of C. striatum was conducted by cloning the 16S rRNA gene. It was found that isolates in the same department had high homology and tended to be located in the same branch or to be crossed in the same main branch. The strains in the same evolutionary branch group had the same drug resistance. Screening of site-specific recombinant elements revealed that 18 strains had integrase genes with the same sequence. This study shows that there may be mobile genetic elements in clinical isolates that drive gene exchange among strains, thus causing the cross-infection, spread and evolution of pathogenic bacteria in the hospital.
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Affiliation(s)
- Jiao Wang
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang 441053, China
- Correspondence: (J.W.); (J.P.)
| | - Jiao Pei
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China
- Correspondence: (J.W.); (J.P.)
| | - Mingming Liu
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang 441053, China
| | - Rui Huang
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang 441053, China
| | - Jiqiang Li
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang 441053, China
| | - Shiying Liao
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang 441053, China
| | - Jian Liang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China
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6
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Sun W, Ma L, Li Y, Xu Y, Wei J, Sa L, Chen X, Su J. In vitro Studies of Non-Diphtheriae Corynebacterium Isolates on Antimicrobial Susceptibilities, Drug Resistance Mechanisms, and Biofilm Formation Capabilities. Infect Drug Resist 2022; 15:4347-4359. [PMID: 35971555 PMCID: PMC9375566 DOI: 10.2147/idr.s376328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to investigate the antimicrobial susceptibilities, drug resistance mechanisms, and biofilm formation capacities of non-diphtheriae Corynebacterium strains isolated from sterile midstream urine of hospitalized patients with clinical urinary tract infections (UTIs). Methods A total of 45 non-diphtheriae Corynebacterium isolates were recovered from sterile midstream urine. The available data of 45 patients were collected. Minimum inhibitory concentrations (MICs) of 10 commonly used antibiotics were determined. Meanwhile, the molecular resistance mechanisms of each agent were performed through PCR with specific primers. Moreover, the biofilm formation capability of each isolate on abiotic surfaces was detected with the MTT method. Results In this study, the most prevalent three species were C. striatum (15/45, 33.3%), C. glucuronolyticum (9/45, 20.0%) and C. urealyticum (8/45, 17.8%). These three species also accounted for most renal and ureteral calculi cases. Male patients older than 50 years, especially those with underlying diseases, were more susceptible to non-diphtheriae Corynebacterium infection. All the 45 isolates were 100% susceptible to vancomycin and linezolid, but highly resistant to macrolide–lincosamide–streptogramin B (MLSB), fluoroquinolones, tetracyclines and β-lactams with corresponding mechanisms. The detection rate of multidrug–resistant (MDR) non-diphtheriae Corynebacterium is 91.1%. All isolates are able to form biofilm on abiotic surfaces, except those of C. urealyticum, C. tuberculostearicum and C. jeikeium. Isolates of C. glucuronolyticum and C. Striatum possessed the strongest biofilm formation capacity. C. amycolatum could form biofilm, but varied greatly among different isolates. Conclusion C. striatum, C. glucuronolyticum and C. urealyticum were the most prevalent species relevant to UTIs. The high occurrence of MDR isolates and high diversities in resistance profiles, and the distinctive abilities of biofilm formation highlighted the urgency for identification to species level. We should pay more attention to the drug resistance profiles of non-diphtheriae Corynebacterium, which would help improve empirical antibiotic therapy and reduce drug resistance transmission.
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Affiliation(s)
- Wei Sun
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Liyan Ma
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Yana Li
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Ying Xu
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Jingjuan Wei
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Lei Sa
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Xinxin Chen
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Jianrong Su
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
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7
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Navarro-Jiménez G, Fuentes-Santos C, Moreno-Núñez L, Alfayate-García J, Campelo-Gutierrez C, Sanz-Márquez S, Pérez-Fernández E, Velasco-Arribas M, Hervás-Gómez R, Martín-Segarra O, Losa-García JE. Experience in the use of dalbavancin in diabetic foot infection. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:296-301. [PMID: 35490091 DOI: 10.1016/j.eimce.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital. METHODS A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate is estimated at 90 days after finishing the treatment. RESULTS A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000 mg followed by 500 mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%). CONCLUSION Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.
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Affiliation(s)
- Gema Navarro-Jiménez
- Servicio de Medicina interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | | | - Leonor Moreno-Núñez
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Jesús Alfayate-García
- Servicio de Cirugía Vascular, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | - Sira Sanz-Márquez
- Servicio de Farmacia, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Elia Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María Velasco-Arribas
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Rafael Hervás-Gómez
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Oriol Martín-Segarra
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Juan Emilio Losa-García
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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8
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Milosavljevic MN, Milosavljevic JZ, Kocovic AG, Stefanovic SM, Jankovic SM, Djesevic M, Milentijevic MN. Antimicrobial treatment of Corynebacterium striatum invasive infections: a systematic review. Rev Inst Med Trop Sao Paulo 2021; 63:e49. [PMID: 34161555 PMCID: PMC8216692 DOI: 10.1590/s1678-9946202163049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/07/2021] [Indexed: 01/03/2023] Open
Abstract
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 β-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.
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Affiliation(s)
- Milos N Milosavljevic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacology and toxicology, Kragujevac, Serbia
| | - Jovana Z Milosavljevic
- University of Kragujevac, Faculty of Medical Sciences, Department of Anatomy, Kragujevac, Serbia
| | - Aleksandar G Kocovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia
| | - Srdjan M Stefanovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacy, Kragujevac, Serbia
| | - Slobodan M Jankovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Pharmacology and toxicology, Kragujevac, Serbia
| | - Miralem Djesevic
- Private Policlinic Center Eurofar Sarajevo, Cardiology Department, Sarajevo, Bosnia and Herzegovina
| | - Milica N Milentijevic
- University of Priština, School of Medicine, Department of Infectious Diseases, Pristina, Serbia
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9
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Navarro-Jiménez G, Fuentes-Santos C, Moreno-Núñez L, Alfayate-García J, Campelo-Gutierrez C, Sanz-Márquez S, Pérez-Fernández E, Velasco-Arribas M, Hervás-Gómez R, Martín-Segarra O, Losa-García JE. Experience in the use of dalbavancin in diabetic foot infection. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30416-X. [PMID: 33451810 DOI: 10.1016/j.eimc.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital. METHODS A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate was estimated at 90 days after finishing the treatment. RESULTS A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000mg followed by 500mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%). CONCLUSION Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.
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Affiliation(s)
- Gema Navarro-Jiménez
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | | | - Leonor Moreno-Núñez
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Jesús Alfayate-García
- Servicio de Cirugía Vascular, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - Sira Sanz-Márquez
- Servicio de Farmacia, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Elia Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - María Velasco-Arribas
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Rafael Hervás-Gómez
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Oriol Martín-Segarra
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Juan Emilio Losa-García
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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10
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Asgin N, Otlu B. Antimicrobial Resistance and Molecular Epidemiology of Corynebacterium striatum Isolated in a Tertiary Hospital in Turkey. Pathogens 2020; 9:pathogens9020136. [PMID: 32093060 PMCID: PMC7168331 DOI: 10.3390/pathogens9020136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 01/14/2023] Open
Abstract
Although Corynebacterium striatum is part of the human flora, it has recently drawn attention both for its multidrug resistance and its role as an invasive infection/outbreak agent. This cross-sectional study aimed to determine the antimicrobial resistance and clonal relationships among C. striatum strains. In total, 81 C. striatum strains were identified using Phoenix-100TM (BD, Sparks, MD, USA). The antimicrobial resistance of the strains was determined using the Kirby–Bauer disk diffusion method. Clonal relatedness among the strains was performed via arbitrarily primed polymerase chain reaction (AP-PCR). All 81 C. striatum strains were resistant to penicillin, cefotaxime, ciprofloxacin, and tetracycline, but susceptible to vancomycin and linezolid. The resistance rates to gentamicin, erythromycin, and clindamycin were 34.6%, 79%, and 87.7% respectively. AP-PCR results showed no predominant clone among the C. striatum strains. Corynebacterium striatum is reportedly the cause of an increasing number of invasive infections/outbreaks. Moreover, treatment options are limited. The study showed that vancomycin, linezolid, and gentamicin can be selected for the empirical treatment of C. striatum infections. Although no single-clone outbreak was observed in our hospital, small clonal circulations were observed within some units, indicating cross-contamination. Therefore, a comprehensive infection control program is warranted in future.
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Affiliation(s)
- Nergis Asgin
- Department of Medical Microbiology, Faculty of Medicine, Karabuk University, 78100 Karabuk, Turkey
- Correspondence: ; Tel.: +90-370-4189446
| | - Baris Otlu
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, 44280 Malatya, Turkey;
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11
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Wang X, Zhou H, Chen D, Du P, Lan R, Qiu X, Hou X, Liu Z, Sun L, Xu S, Ji X, Li H, Li D, Zhang J, Zeng H, Li Z. Whole-Genome Sequencing Reveals a Prolonged and Persistent Intrahospital Transmission of Corynebacterium striatum, an Emerging Multidrug-Resistant Pathogen. J Clin Microbiol 2019; 57:e00683-19. [PMID: 31315959 PMCID: PMC6711910 DOI: 10.1128/jcm.00683-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Corynebacterium striatum is an emerging multidrug-resistant (MDR) pathogen that occurs primarily among immunocompromised and chronically ill patients. However, little is known about the genomic diversity of C. striatum, which contributes to its long-term persistence and transmission in hospitals. In this study, a total of 192 C. striatum isolates obtained from 14 September 2017 to 29 March 2018 in a hospital in Beijing, China, were analyzed by antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE). Whole-genome sequencing was conducted on 91 isolates. Nearly all isolates (96.3%, 183/190) were MDR. The highest resistance rate was observed for ciprofloxacin (99.0%, 190/192), followed by cefotaxime (90.6%, 174/192) and erythromycin (89.1%, 171/192). PFGE separated the 192 isolates into 79 pulsotypes, and differences in core genome single-nucleotide polymorphisms (SNPs) partitioned the 91 isolates sequenced into four clades. Isolates of the same pulsotype were identical or nearly identical at the genome level, with some exceptions. Two dominant subclones, clade 3a, and clade 4a, were responsible for the hospital-wide dissemination. Genomic analysis further revealed nine resistance genes mobilized by eight unique cassettes. PFGE and whole-genome sequencing revealed that the C. striatum isolates studied were the result mainly of predominant clones spreading in the hospital. C. striatum isolates in the hospital progressively acquired resistance to antimicrobial agents, demonstrating that isolates of C. striatum may adapt rapidly through the acquisition and accumulation of resistance genes and thus evolve into dominant and persistent clones. These insights will be useful for the prevention of C. striatum infection in hospitals.
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Affiliation(s)
- Xuebing Wang
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Haijian Zhou
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Dongke Chen
- Department of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Pengcheng Du
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - Xiaotong Qiu
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Xuexin Hou
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Zhiguo Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Lina Sun
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Shuai Xu
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Xingzhao Ji
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Heqiao Li
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Dan Li
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Jingshan Zhang
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Hui Zeng
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhenjun Li
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
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