Volume 28, Number 11—November 2022
CME ACTIVITY - Synopsis
Severe Pneumonia Caused by Corynebacterium striatum in Adults, Seoul, South Korea, 2014–2019
Introduction
In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at https://www.medscape.org/journal/eid; and (4) view/print certificate.
Upon completion of this activity, participants will be able to:
Assess the proportion, demographics, underlying diseases, and pathogens of severe Corynebacterium striatum hospital-acquired pneumonia in adults compared with those of severe methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia, based on a retrospective study
Evaluate the clinical characteristics, laboratory findings, and outcomes of severe Corynebacterium striatum hospital-acquired pneumonia in adults compared with those of severe methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia, based on a retrospective study
Determine the clinical implications of the proportion, clinical characteristics, and outcomes of severe Corynebacterium striatum hospital-acquired pneumonia in adults compared with those of severe methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia, based on a retrospective study
Amy J. Guinn, BA, MA, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Amy J. Guinn, BA, MA, has disclosed no relevant financial relationships.
Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has the following relevant financial relationships: formerly owned stocks in AbbVie Inc.
Yun Woo Lee, MD, MS; Jin Won Huh, MD, PhD; Sang-Bum Hong, MD, PhD; Jiwon Jung, MD, PhD; Min Jae Kim, MD, PhD; Yong Pil Chong, MD, PhD; Sung-Han Kim, MD, PhD; Heungsup Sung, MD, PhD; Kyung-Hyun Do, MD, PhD; Sang-Oh Lee, MD, PhD; Chae-Man Lim, MD, PhD; Yang Soo Kim, MD, PhD; Younsuck Koh, MD, PhD; and Sang-Ho Choi, MD, PhD.
Abstract
We investigated the proportion and characteristics of severe Corynebacterium striatum pneumonia in South Korea during 2014–2019. As part of an ongoing observational study of severe pneumonia among adult patients, we identified 27 severe C. striatum pneumonia cases. Most (70.4%) cases were hospital-acquired, and 51.9% of patients were immunocompromised. C. striatum cases among patients with severe hospital-acquired pneumonia (HAP) increased from 1.0% (2/200) during 2014–2015 to 5.4% (10/185) during 2018–2019, but methicillin-resistant Staphylococcus aureus (MRSA) infections among severe HAP cases decreased from 12.0% to 2.7% during the same timeframe. During 2018–2019, C. striatum was responsible for 13.3% of severe HAP cases from which bacterial pathogens were identified. The 90-day mortality rates were similarly high in the C. striatum and MRSA groups. C. striatum was a major cause of severe HAP and had high mortality rates. This pathogen is emerging as a possible cause for severe pneumonia, especially among immunocompromised patients.
Corynebacterium striatum is a nonlipophilic, fermentative coryneform bacterium that commonly occupies the normal flora of the skin and oropharynx (1). Although C. striatum isolated from clinical specimens has frequently been considered a contaminant, it is increasingly recognized as a pathogen of various infections, including central line-associated bacteremia (2), endocarditis (3), and pleuropulmonary infection (4–6). In 1980, C. striatum was reported as a cause of pleuropulmonary infection in a patient with chronic lymphocytic leukemia (4). In 2018, a group of researchers in the United States reported 3 cases of community-acquired pneumonia (CAP) in which Corynebacterium species were the predominant isolate and suggested that Corynebacterium species are a noteworthy clinical cause of pneumonia (6). However, scarce information is available on the incidence, clinical characteristics, and outcomes of severe C. striatum pneumonia in critically ill adult patients, because previous studies included <5 patients with severe C. striatum pneumonia, except those reporting hospital outbreak events.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of severe hospital-acquired pneumonia (HAP), and the clinical characteristics and outcomes of severe MRSA pneumonia are well-documented. Therefore, comparing C. striatum and MRSA pneumonia could clarify the clinical characteristics of C. striatum pneumonia for clinicians. We investigated the proportion, clinical characteristics, and outcomes of severe C. striatum pneumonia in adults and compared those aspects with those for severe MRSA pneumonia.
Study Design, Setting, Data Collection, and Patient Selection
This study is part of an ongoing prospective observational study on severe pneumonia in critically ill adult (>16 years of age) patients at Asan Medical Center, a 2,700-bed tertiary referral center in Seoul, South Korea. Since March 2010, we have prospectively identified all adult patients admitted to the 28-bed medical intensive care unit (ICU) who were clinically suspected of having severe pneumonia and monitored them until hospital discharge (7–10). We collected data on patient demographics; underlying diseases or conditions; category of pneumonia; initial clinical manifestations; laboratory, microbiologic, and radiologic findings; treatment; complications; and mortality rates. For this study, we investigated patients with severe C. striatum pneumonia who were admitted to the medical ICU during January 2014–December 2019. This study was approved by the institutional review board of Asan Medical Center (IRB no. 2010–0079), which waived the need for informed consent due to the observational nature of the study.
Definitions
We defined and categorized pneumonia as previously stated (11–13). We defined severe pneumonia as the necessity for mechanical ventilation or having septic shock at ICU admission (12). We defined sepsis and septic shock according to Sepsis-3 criteria (14). We defined immunocompromised state as described previously (15).
C. striatum Identification and Antimicrobial Susceptibility Testing
We cultured sputum specimens on a 5% sheep blood plate and MacConkey agar (Synergy Innovation, http://www.synergyinno.com). When coryneform gram-positive bacilli were isolated, we identified and performed antimicrobial susceptibility testing for specimens that were urea positive or from the ICU (16). We quantitatively cultured bronchoalveolar lavage specimens on chocolate agar and identified and performed susceptibility testing were conducted when coryneform gram-positive bacilli exclusively grew at >104 CFU/mL (16). Until August 2015, our facility used the triple sugar iron, motility, API Coryne (bioMérieux-Vitek, https://www.biomerieux.com) system to identify coryneform gram-positive rods. In September 2015, our facility began using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (Bruker Daltonik, https://www.bruker.com). We determined antimicrobial susceptibility profiles by ETEST (bioMérieux-Vitek) with MHF medium (Mueller-Hinton agar with 5% horse blood + 20 mg/L β-NAD; bioMérieux-Vitek). We used the Clinical and Laboratory Standards Institute M45 guideline for interpreting susceptibility test results (17) and defined multidrug resistance as resistance to >3 antimicrobial drug families.
Statistical Analysis
We compared patient demographics, underlying diseases and conditions, and clinical and laboratory parameters between the C. striatum group and the MRSA group. We used χ2 or Fisher exact test to compare categorical variables and Student t-test or Mann-Whitney U test to compare continuous variables. We analyzed changes in the proportions of pneumonic pathogens over time by using a χ2 test for trend. We performed all analyses in SPSS Statistics 24.0 (IBM Corp., https://www.ibm.com) and considered p<0.05 statistically significant.
Demographics, Underlying Diseases and Conditions, and Pneumonia Categories
During the study period, we identified a total of 1,740 patients with severe pneumonia. Among them, 27 had severe C. striatum pneumonia and 103 had severe MRSA pneumonia (Table 1). The median patient age in the C. striatum group was 72.0 years and in the MRSA group was 71.0 years. Solid cancer, diabetes mellitus, and structural lung diseases were the most common underlying conditions in both groups. More patients in the C. striatum group were immunocompromised (51.9% vs. 26.2%; p = 0.01). Most (70.4%) patients in the C. striatum group had HAP, 14.8% had healthcare-associated pneumonia (HCAP), 11.1% had ventilator-associated pneumonia, and 3.7% had CAP. HAP was significantly more common in the C. striatum group than the MRSA group (70.4% vs. 42.7%; p = 0.01); HCAP was more common in the MRSA group (32.0% vs. 14.8%; p = 0.08), albeit without statistical significance.
Bacterial Pathogens Identified in Severe HAP Patients
We identified bacterial pathogens in 565 patients who had severe HAP during 2014–2019 (Table 2). The proportion of severe MRSA HAP decreased significantly, from 12.0% (24/200) in 2014–2015 to 2.7% (5/185) in 2018–2019 (p<0.01), whereas the proportion of severe C. striatum HAP increased significantly, from 1.0% (2/200) in 2014–2015 to 5.4% (10/185) in 2018–2019 (p<0.001). Among 75 HAP cases from which bacterial pathogens were identified in 2018–2019, C. striatum was responsible for 13.3% (10/75) of cases, which was the fourth most common pathogen, after Acinetobacter baumannii (30.7%), Klebsiella pneumoniae (21.3%), and Pseudomonas aeruginosa (14.7%).
Coinfections
We identified co-infection pathogens in 13 (48.1%) patients in the C. striatum group and 37 (35.9%) patients in the MRSA group (p = 0.25) (Table 3). Co-infection with other bacteria was more common in the MRSA group (25.2% vs. 7.4%; p = 0.045), whereas viral co-infection was more common in the C. striatum group (33.3% vs. 14.6%; p = 0.047). Fungal co-infection, which included 4 Aspergillus species and 1 Pneumocystis jirovecii, was only found in the C. striatum group (14.8% vs. 0%; p<0.01).
Clinical Manifestations and Laboratory Findings
Dyspnea, fever, sputum, and cough were the most common signs and symptoms in both groups (Table 4). Fever tended to be less common in the C. striatum group (66.7% vs. 82.5%; p = 0.07). The proportion of patients with septic shock at the time of ICU admission was significantly higher in the MRSA group (67.0% vs. 44.4%; p = 0.03). However, the proportion of mechanical ventilation, acute physiology and chronic health evaluation (APACHE II) score, and sequential organ failure assessment (SOFA) score at the time of ICU admission were similar between the 2 groups. Peripheral leukocyte counts, platelet counts, and serum C-reactive protein levels also were similar between the 2 groups, but serum procalcitonin level was significantly higher in the MRSA group than the C. striatum group (median 0.3 ng/mL vs. 1.8 ng/mL; p<0.01).
C. striatum Gram Stain, Culture, and Antimicrobial Susceptibility Testing
On microscopic examination of Gram stain specimens, gram-positive rods were identified in 69.2% (18/26) of specimens. Among 27 cases, 10 were quantitative cultures and 17 were semiquantitative cultures. Bacterial counts were >105 CFU/mL in 8/10 quantitative cultures. Of the 17 semiquantitative culture specimens, 12 specimens were grade many (4+), 1 was grade moderate (3+), 1 grade few (2+), and 3 were grade rare (1+) (Appendix Table). All 27 C. striatum isolates underwent antimicrobial susceptibility testing. All isolates were resistant to penicillin, ceftriaxone, erythromycin, and ciprofloxacin, and susceptible to vancomycin, and all isolates were multidrug resistant.
Outcomes
The mortality rates between the C. striatum and MRSA group showed no statistically significant differences: 30-day mortality (40.7% vs. 29.1%; p = 0.25), 60-day (48.1% vs. 42.7%; p = 0.61), and 90-day (59.3% vs. 50.5%; p = 0.42) (Table 5). In-hospital mortality rates were higher (70.4%) in the C. striatum group than in the MRSA group (52.4%), albeit without statistical significance (p = 0.09). Mortality rates were similar for C. striatum and MRSA in subgroups regardless of the patient’s immune status. We noted no statistically significant differences in the median length of ICU stay between the C. striatum and MRSA group, both 14 days (p = 0.33), nor in the length of hospital stay after ICU admission, 30 days for the C. striatum versus 29 days for the MRSA group (p = 0.48).
We investigated the proportion and characteristics of severe C. striatum pneumonia compared with severe MRSA pneumonia. Although the proportion of severe MRSA HAP greatly decreased during 2014–2019, the proportion of severe C. striatum pneumonia sharply increased and surpassed that of severe MRSA pneumonia. C. striatum pneumonia was more commonly associated with immunocompromise, viral co-infection, and fungal co-infection. Mortality rates between the C. striatum and MRSA groups were comparable.
We found that the proportion of severe MRSA pneumonia decreased while severe C. striatum pneumonia greatly increased and that C. striatum emerged as one of the most common pathogens in patients with severe HAP. Strengthened infection control measures during the study period might have contributed to the decline of severe MRSA pneumonia (18); however, severe C. striatum pneumonia demonstrated the opposite trend. Several possible explanations for this discrepancy exist. First, detection of C. striatum from respiratory specimens in clinical laboratories increased, possibly because experience among laboratory staff accumulated over time. Also, new reliable identification techniques, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, were introduced and enabled precise and rapid detection and identification of bacteria in clinical samples, which might have contributed to the increased reports of severe C. striatum pneumonia (19,20). Second, C. striatum can be resistant to infection control measures and can adhere to abiotic surfaces and form biofilms on various medical devices, such as feeding tubes, endotracheal tubes, and ventilators (21,22). Some reports documented C. striatum strains with resistance to high-level disinfectants, such as 2% glutaraldehyde and other biocides (23,24). These findings suggest that appropriate environmental infection control measures for C. striatum should be further investigated and implemented. Finally, hospital outbreaks also might have contributed to the seeming discrepancy. Colonized patients and contaminated inanimate objects could be reservoirs for prolonged outbreaks. However, when we chronologically analyzed the occurrence patterns according to time and place, we could not find any suggestions of notable outbreaks. Clinical observation alone creates difficulties and limitations in distinguishing outbreaks; therefore, future studies should include more detailed typing analysis of C. striatum isolates to identify and curb possible healthcare-associated outbreaks.
In this study, viral or fungal co-infection was more common in the C. striatum group, whereas other bacterial co-infection was more common in the MRSA group. This finding could represent the host factor because a greater proportion of C. striatum patients were in an immunocompromised state, which would make them vulnerable to opportunistic infections. Of note, fewer cases of bacterial coinfection were diagnosed in the C. striatum group, but the cause for this difference is uncertain. One possible explanation is that C. striatum might influence the behavior and fitness of other bacteria. A recent study reported that Corynebacterium species can reduce the toxicity of Staphylococcus aureus by exhibiting decreased hemolysin activity and displaying diminished fitness of in vivo coinfection (25). Further targeted studies on this issue are needed.
We found that serum procalcitonin level was higher in the MRSA group than in the C. striatum group (median 1.8 ng/mL vs. 0.3 ng/mL). Some studies suggest that serum procalcitonin can be used as a marker for bacterial infection and to differentiate bacterial from viral infection or noninfectious causes of inflammation (26,27). In 2017, a group of researchers in China reported that the median serum procalcitonin level of an S. aureus bacteremia group of patients was higher (1.18 ng/mL) than that of a coagulase-negative staphylococci bacteremia group (0.21–0.31 ng/mL) (28). We speculate that infections caused by low-virulence bacteria, such as C. striatum in our study, might have low levels of procalcitonin and this warrants further investigation.
Mortality rates were similarly high in both groups, but septic shock at the time of initial clinical manifestation was less common in the C. striatum group. Immunocompromised conditions were more common in the C. striatum group, which could suggest that C. striatum is less virulent than MRSA. Host factor might contribute to the development of severe C. striatum–associated pneumonia and the subsequent outcomes; however, we noted no statistically significant differences in mortality rates between the 2 groups after stratification by immunocompromised conditions. The existence of co-infection and pathogen types (e.g., other bacteria, viruses, fungi) involved might have affected mortality rates, but we were unable to effectively evaluate each effect because of the small number of patients in each subgroup.
The first limitation of our study is that we used a single-center design and our results might not be replicable in other centers or hospital systems. In addition, as we mentioned previously, we were not able to effectively evaluate the sole contribution of C. striatum because co-infection with other pathogens was common among the patient cohort. Finally, we included all C. striatum isolates from sputum, endotracheal aspirate, and bronchoalveolar lavage, but the cultures were mostly semiquantitative, and some of the C. striatum isolates might have been nonpathogenic colonizers. A 2020 study from the United States reported that normal respiratory flora appears to have caused one quarter of CAP cases (29), which supports our finding that bacteria previously considered as colonizers or normal flora can be a cause of pneumonia.
In conclusion, we found C. striatum was associated with severe HAP. Patients with severe C. striatum pneumonia showed similar clinical and laboratory features as patients with severe MRSA pneumonia, and both infections were associated with high mortality rates. Further investigations could clarify incidence, clinical characteristics, and outcomes of severe C. striatum pneumonia in critically ill adults and determine whether infections are due to colonization, or community- or healthcare-acquired infections. Clinicians should be aware of this emerging pathogen as a possible cause for severe pneumonia, especially among immunocompromised patients.
Acknowledgment
This work was supported by the Asan Institute of Life Sciences (grant no. 2010-0079) and generous gifts from Sam Won Song.
References
- Funke G, von Graevenitz A, Clarridge JE III, Bernard KA. Clinical microbiology of coryneform bacteria. Clin Microbiol Rev. 1997;10:125–59. DOIPubMedGoogle Scholar
- Chen FL, Hsueh PR, Teng SO, Ou TY, Lee WS. Corynebacterium striatum bacteremia associated with central venous catheter infection. J Microbiol Immunol Infect. 2012;45:255–8. DOIPubMedGoogle Scholar
- Hong HL, Koh HI, Lee AJ. Native valve endocarditis due to Corynebacterium striatum confirmed by 16S ribosomal RNA sequencing: a case report and literature review. Infect Chemother. 2016;48:239–45. DOIPubMedGoogle Scholar
- Bowstead TT, Santiago SM Jr. Pleuropulmonary infection due to Corynebacterium striatum. Br J Dis Chest. 1980;74:198–200. DOIPubMedGoogle Scholar
- Díez-Aguilar M, Ruiz-Garbajosa P, Fernández-Olmos A, Guisado P, Del Campo R, Quereda C, et al. Non-diphtheriae Corynebacterium species: an emerging respiratory pathogen. Eur J Clin Microbiol Infect Dis. 2013;32:769–72. DOIPubMedGoogle Scholar
- Yang K, Kruse RL, Lin WV, Musher DM. Corynebacteria as a cause of pulmonary infection: a case series and literature review. Pneumonia (Nathan). 2018;10:10. DOIPubMedGoogle Scholar
- Choi SH, Hong SB, Ko GB, Lee Y, Park HJ, Park SY, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012;186:325–32. DOIPubMedGoogle Scholar
- Hong HL, Hong SB, Ko GB, Huh JW, Sung H, Do KH, et al. Viral infection is not uncommon in adult patients with severe hospital-acquired pneumonia. PLoS One. 2014;9:
e95865 . DOIPubMedGoogle Scholar - Choi SH, Hong SB, Hong HL, Kim SH, Huh JW, Sung H, et al. Usefulness of cellular analysis of bronchoalveolar lavage fluid for predicting the etiology of pneumonia in critically ill patients. PLoS One. 2014;9:
e97346 . DOIPubMedGoogle Scholar - Choi SH, Huh JW, Hong SB, Lee JY, Kim SH, Sung H, et al. Clinical characteristics and outcomes of severe rhinovirus-associated pneumonia identified by bronchoscopic bronchoalveolar lavage in adults: comparison with severe influenza virus-associated pneumonia. J Clin Virol. 2015;62:41–7. DOIPubMedGoogle Scholar
- American Thoracic SocietyInfectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416. DOIPubMedGoogle Scholar
- Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al.; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27–72. DOIPubMedGoogle Scholar
- Carratalà J, Mykietiuk A, Fernández-Sabé N, Suárez C, Dorca J, Verdaguer R, et al. Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med. 2007;167:1393–9. DOIPubMedGoogle Scholar
- Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10. DOIPubMedGoogle Scholar
- Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother. 2007;51:3568–73. DOIPubMedGoogle Scholar
- Gilligan PH, Alby K, York MK. Respiratory tract cultures. In: Leber AL, editor. Clinical microbiology procedures handbook, 4th edition, volume 1. Washington: ASM Press; 2016. pp. 3.11.1.1–9.4.
- Clinical and Laboratory Standards Institute. Methods for antimicrobial dilution and disk susceptibility testing of infrequently isolated or fastidious bacteria, third edition (M45). Wayne (PA): The Institute; 2016.
- Kim H, Kim ES, Lee SC, Yang E, Kim HS, Sung H, et al. Decreased Incidence of methicillin-resistant Staphylococcus aureus bacteremia in intensive care units: a 10-year clinical, microbiological, and genotypic analysis in a tertiary hospital. Antimicrob Agents Chemother. 2020;64:e01082–20. DOIPubMedGoogle Scholar
- Khamis A, Raoult D, La Scola B. Comparison between rpoB and 16S rRNA gene sequencing for molecular identification of 168 clinical isolates of Corynebacterium. J Clin Microbiol. 2005;43:1934–6. DOIPubMedGoogle Scholar
- Vila J, Juiz P, Salas C, Almela M, de la Fuente CG, Zboromyrska Y, et al. Identification of clinically relevant Corynebacterium spp., Arcanobacterium haemolyticum, and Rhodococcus equi by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2012;50:1745–7. DOIPubMedGoogle Scholar
- Souza C, Faria YV, Sant’Anna LO, Viana VG, Seabra SH, Souza MC, et al. Biofilm production by multiresistant Corynebacterium striatum associated with nosocomial outbreak. Mem Inst Oswaldo Cruz. 2015;110:242–8. DOIPubMedGoogle Scholar
- Ramos JN, Souza C, Faria YV, da Silva EC, Veras JFC, Baio PVP, et al. Bloodstream and catheter-related infections due to different clones of multidrug-resistant and biofilm producer Corynebacterium striatum. BMC Infect Dis. 2019;19:672. DOIPubMedGoogle Scholar
- Souza C, Mota HF, Faria YV, Cabral FO, Oliveira DR, Sant’Anna LO, et al. Resistance to antiseptics and disinfectants of planktonic and biofilm-associated forms of Corynebacterium striatum. Microb Drug Resist. 2020;26:1546–58. DOIPubMedGoogle Scholar
- Silva-Santana G, Silva CMF, Olivella JGB, Silva IF, Fernandes LMO, Sued-Karam BR, et al. Worldwide survey of Corynebacterium striatum increasingly associated with human invasive infections, nosocomial outbreak, and antimicrobial multidrug-resistance, 1976-2020. Arch Microbiol. 2021;203:1863–80. DOIPubMedGoogle Scholar
- Ramsey MM, Freire MO, Gabrilska RA, Rumbaugh KP, Lemon KP. Staphylococcus aureus shifts toward commensalism in response to Corynebacterium species. Front Microbiol. 2016;7:1230. DOIPubMedGoogle Scholar
- Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39:206–17. DOIPubMedGoogle Scholar
- Limper M, de Kruif MD, Duits AJ, Brandjes DP, van Gorp EC. The diagnostic role of procalcitonin and other biomarkers in discriminating infectious from non-infectious fever. J Infect. 2010;60:409–16. DOIPubMedGoogle Scholar
- Yan ST, Sun LC, Jia HB, Gao W, Yang JP, Zhang GQ. Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria. Am J Emerg Med. 2017;35:579–83. DOIPubMedGoogle Scholar
- Musher DM, Jesudasen SS, Barwatt JW, Cohen DN, Moss BJ, Rodriguez-Barradas MC. Normal respiratory flora as a cause of community-acquired pneumonia. Open Forum Infect Dis. 2020;7:ofaa307.
Figure
Tables
Follow Up
To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 75% passing score) and earn continuing medical education (CME) credit, please go to https://www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers.
You must be a registered user on http://www.medscape.org. If you are not registered on http://www.medscape.org, please click on the “Register” link on the right hand side of the website.
Only one answer is correct for each question. Once you successfully answer all post-test questions, you will be able to view and/or print your certificate. For questions regarding this activity, contact the accredited provider,
You are advising a large hospital regarding prevention and management of Corynebacterium striatum hospital-acquired pneumonia (HAP). On the basis of the retrospective study by Lee and colleagues, which one of the following statements about the proportion, demographics, underlying diseases, and pathogens of severe C. striatum HAP in adults compared with those of severe methicillin-resistant Staphylococcus aureus (MRSA) HAP is correct?
Of 27 severe C. striatum pneumonia cases during 2014 to 2019 in Seoul, South Korea, 70.4% were hospital-acquired and 51.9% were immunocompromised
From 2014-2015 to 2018-2019, the proportion of C. striatum did not change, although that of MRSA significantly increased in patients with severe HAP
During 2018 to 2019, C. striatum was responsible for 5.3% of severe HAP cases from which bacterial pathogens were identified
Coinfection with virus or fungi was more common in the MRSA group, whereas bacterial coinfection was more common in the C. striatum group
On the basis of the retrospective study by Lee and colleagues, which one of the following statements about the clinical characteristics, laboratory findings, and outcomes of severe C. striatum HAP in adults, compared with those of severe MRSA HAP is correct?
Fever and septic shock were less common in the MRSA group than in the C. striatum group
Peripheral white blood cells (WBC), platelet counts, and serum C-reactive protein (CRP) were significantly more abnormal in the MRSA group
Half of C. striatum isolates had antibiotic multiresistance
Mortality rates were similarly high in the C. striatum and MRSA groups
According to the retrospective study by Lee and colleagues, which one of the following statements about the clinical implications of the proportion, clinical characteristics, and outcomes of severe C. striatum HAP in adults compared with those of severe MRSA HAP is correct?
The study proves that C. striatum is resistant to infection control measures
All C. striatum strains were highly sensitive to high-level disinfectants
The study highlights the effect of C. striatum as an emerging pathogen for severe HAP, warranting further investigation
The study offers no evidence that C. striatum may affect behavior and fitness of other bacteria
Original Publication Date: October 05, 2022
1These authors contributed equally to this article.
Related Links
Table of Contents – Volume 28, Number 11—November 2022
| EID Search Options |
|---|
Advanced Article Search – Search articles by author and/or keyword.
|
Articles by Country Search – Search articles by the topic country.
|
Article Type Search – Search articles by article type and issue.
|
Please use the form below to submit correspondence to the authors or contact them at the following address:
Sang-Ho Choi, Department of Infectious Diseases, Asan Medical Center, 88 Olympic-Ro 43-Gil Pungnap-dong, Songpa-gu, Seoul 05505, South Korea
Top