Infective Endocarditis Due to Corynebacterium Species: Clinical Features and Antibiotic Resistance

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.

Keywords: Corynebacterium; antibiotic; infective endocarditis.

Figure 1.

Flowchart of inclusion and exclusions of episodes of infective endocarditis (IE) reported to the Swedish Registry of Infective Endocarditis (SRIE). Cases of IE were identified through the SRIE. Cases of IE due to Corynebacterium, Staphylococcus aureus, non-beta hemolytic (Non-BHS ) streptococci, and Enterococcus faecalis were included in the study. Non-BHS comprised bacteria reported to the SRIE as alpha-hemolytic streptococci, Streptococcus bovis, Granulicatella, or Abiotrophia. *, Cases registered as rejected IE according to the modified Duke criteria. **, Cases registered as blood and/or valve culture negative (with or without polymerase chain reaction). ***, One case of IE due to Corynebacterium was registered twice.