Corynebacterium striatum thrombophlebitis: a nosocomial multidrug-resistant disease?

Abstract

Introduction: Corynebacterium striatum is a non-Diphteriae commensal bacterium with a wide range of pathogenicity. The identification of multidrug-resistant (MDR) C. striatum is concerning because drug susceptibility testing is not usually performed in microbiology laboratories. There is no consensus yet on the treatment of septic thrombophlebitis in this situation.

Case report: We report here the first case of a quinquagenarian patient with a history of AIDS and fungic endocarditis, who was diagnosed with a nosocomial thrombophlebitis in the right jugular vein caused by C. striatum . Bitherapy with daptomycin for 12 days and linezolid for 23 days was combined with a therapeutic anticoagulant. The follow-up included weekly cervical ultrasound controls. The efficiency of the treatment and the stability of the lesions allowed us to alleviate the medication with a prophylactic dose of anticoagulant. The patient was discharged from hospital and showed no signs of recurrence after 12 months.

Conclusion: The lack of consensus relative to the management of septic thrombophlebitis precludes the validation of a specific treatment for the condition. Our results suggest that a combination that includes removal of the medical device is needed. A total of 6 weeks of antibiotherapy should be applied, starting with 2 weeks of vancomycin or a combination of antibiotitherapy with daptomycin in order to reduce the bacterial load and avoid resistance. Six weeks of anticoagulation therapy is effective.

Keywords: Corynebacterium; multidrug resistance; septic thrombophlebitis.

Fig. 1.

Ultrasound Doppler of the right cervical region performed on 6 November 2019: signs of an enlarged right internal jugular vein with heterogeneous echogenic material (a) over its entire height and taken over by collaterals, which led to the diagnosis of a recent thrombosis of the right internal jugular vein; signs of an infiltration and thickening of soft cervical tissue (b); numerous right cervical infracentimetric lymph nodes; no abscess of the soft parts of the sterno-cleido-mastoid muscle (c) was observed.