Clinical Infection in Practice (Oct 2020)
Corynebacterium bacteremia in patients with hematological malignancies and other medical conditions
Abstract
Background: Corynebacterium species are emerging pathogens that cause hospital-acquired infections as well as bacteremia in patients with hematological malignancies and chronic medical conditions, and are widely resistant to ß-lactam agents. The aim of this study was analyzing the characteristics and prognosis of patients with Corynebacterium bacteremia. Patients and method: We retrospectively collected data on patients with Corynebacterium bacteremia in our institution during 2009–2019 and analyzed the underlying conditions, prognosis, and antibiotic susceptibilities of the causative species. Results: In total, 41 patients were analyzed. Further, 21 patients had hematological malignancies, and 20 had other medical conditions including cancer and organ failure. The most frequently identified strain was C. striatum (63.4%). Although central venous catheter-related bloodstream infection (36.6%) and febrile neutropenia (36.6%) were most commonly observed, the site of infection was not identified in six (14.6%) patients. The 30- and 60-day overall survival rates were 82.9% and 75.6%, respectively. Among 22 patients who died during the observation period, 21 died due to predisposing diseases and not sepsis. Log-rank test identified association between renal dysfunction and sustained positive blood culture with poor prognosis, but no significant association with anti-methicillin-resistant Staphylococcus aureus (MRSA) drug treatment was found. There were no apparent differences in prognosis and characteristics between patients with hematological malignancies and other medical conditions. The median serum procalcitonin level was 0.31 ng/mL. Regarding the bacterial isolates, their percent susceptibilities to antibiotics were as follows: penicillin G, 2.4%; ceftriaxone, 7.3%; clindamycin, 14.6%; levofloxacin, 4.9%; and vancomycin, ≥97.6%. Conclusions: All patients had hematological malignancies or other medical conditions. An apparent infectious focus was not found in half of the patients. The high mortality rate was attributable to the severe predisposing malignancies and medical conditions. The identified strains were highly resistant to penicillin and cephalosporin, but treatment with anti-MRSA drugs did not affect mortality rates.
