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Case Reports
. 2022 Mar 26;22(1):290.
doi: 10.1186/s12879-022-07270-0.

The challenge of antibiotic selection in prosthetic joint infections due to Corynebacterium striatum: a case report

Amber C Streifel  1 , Cara D Varley  2   3 , YoungYoon Ham  4 , Monica K Sikka  4 , James S Lewis 2nd  4   2
Affiliations
Case Reports

The challenge of antibiotic selection in prosthetic joint infections due to Corynebacterium striatum: a case report

Amber C Streifel et al. BMC Infect Dis. .

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.

Keywords: Antimicrobial resistance; Corynebacterium striatum; Daptomycin; Prosthetic joint infection.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Timeline of case events. TMP/SMZ sulfamethoxazole-trimethoprim, DRESS drug rash with eosinophilia and systemic symptoms
See this image and copyright information in PMC

References

    1. Lee PP, Ferguson DA, Sarubbi FA. Corynebacterium striatum: an underappreciated community and nosocomial pathogen. J Infect. 2005;50:338–343. doi: 10.1016/j.jinf.2004.05.005. - DOI - PubMed
    1. Ramos JN, Souza C, Faria YV, da Silva EC, Veras JFC, Baio PVP, Seabra SH, Moreira LO, Junior RH, Mattos-Guaraldi AL, Viera VV. Bloodstream and catheter-related infections due to different clones of multidrug-resistant and biofilm producer Corynebacterium striatum. BMC Infect Dis. 2019;19(672):1–11. - PMC - PubMed
    1. de Souza C, Faria YV, SantAnna LO, Viana VG, Seabra SH, De Souza MC, Vieira VV, Junior RH, Moreira LDO, de Mattos-Guaraldi AL. Biofilm production by multiresistant Corynebacterium striatum associated with nosocomial outbreaks. Mem Inst Oswaldo Cruz. 2015;110(2):242–248. doi: 10.1590/0074-02760140373. - DOI - PMC - PubMed
    1. Suwantarat N, Weik C, Romagnoli M, Ellis BC, Kwiatkowski N, Carroll KC. Practical utility and accuracy of matrix-assisted laser desporption ionization-time of flight mass spectrometry for identification of Corynebacterium species and other medically relevant coryneform-like bacteria. Am J Clin Pathol. 2016;145:22–28. doi: 10.1093/ajcp/aqv006. - DOI - PubMed
    1. Esteban J, Nieto E, Calvo R, Fernandez-Roblas R, Valero-Guillen PL, Soriano F. Microbiological characterization and clinical significance of Corynebacterium amycolatum strains. Eur J Clin Microbiol Infect Dis. 1999;18:518–521. doi: 10.1007/s100960050336. - DOI - PubMed

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