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Table 1.  

Characteristics

Total, n = 130

C. striatum, n = 27

MRSA, n = 103

p value

Sex
   M 92 (70.8) 18 (66.7) 74 (71.8) 0.60
   F 38 (29.2) 9 (33.3) 33 (32.0)  
Median age (interquartile range) 71.0 (63.8–77.0) 72.0 (66.0–80.0) 71.0 (63.0–76.0) 0.17
Underlying disease or condition†
   Solid cancer 32 (24.6) 4 (14.8) 28 (27.2) 0.18
   Diabetes mellitus 30 (23.1) 6 (22.2) 24 (23.3) 0.91
   Structural lung disease 24 (18.5) 4 (14.8) 20 (19.4) 0.78
   Chronic obstructive lung disease 12 (9.2) 3 (11.1) 9 (8.7) 0.71
   Interstitial lung disease 5 (3.8) 0 5 (4.9) 0.58
      Bronchiectasis 4 (3.1) 0 4 (3.9) 0.58
      Destroyed lung due to tuberculosis 1 (0.8) 0 1 (1.0) 1.00
      Pneumoconiosis 1 (0.8) 0 1 (1.0) 1.00
      Bronchiolitis obliterans 1 (0.8) 1 (3.7) 0 0.21
   Hematologic malignancy 13 (10.0) 5 (18.5) 8 (7.8) 0.14
   Liver cirrhosis 11 (8.5) 2 (7.4) 9 (8.7) 1.00
   End-stage renal disease 7 (5.4) 2 (7.4) 5 (4.9) 0.64
   Chronic renal failure 6 (4.6) 3 (11.1) 3 (2.9) 0.10
   Congestive heart failure 3 (2.3) 1 (3.7) 2 (1.9) 0.51
   Alcoholism 2 (1.5) 0 2 (1.9) 1.00
   Cerebrovascular attack 12 (9.2) 5 (18.5) 7 (6.8) 0.13
   Solid organ transplantation 2 (1.5) 0 2 (1.9) 0.63
   Hematopoietic stem cell transplantation 3 (2.3) 2 (7.4) 1 (1.0) 0.11
Immunocompromised state‡ 41 (31.5) 14 (51.9) 27 (26.2) 0.01
   Recent chemotherapy 23 (17.7) 7 (25.9) 16 (15.5) 0.26
   Recent surgery, ≤1 mo 19 (14.6) 2 (7.4) 17 (16.5) 0.36
   Active smoker 10 (7.7) 1 (3.7) 9 (8.7) 0.69
   Neutropenia, <500 cells/mL 8 (6.2) 4 (14.8) 4 (3.9) 0.06
Category of pneumonia
   Community-acquired 6 (4.6) 1 (3.7) 5 (4.9) 1.00
   Healthcare-associated 37 (28.5) 4 (14.8) 33 (32.0) 0.08
   Hospital-acquired 63 (48.5) 19 (70.4) 44 (42.7) 0.01
   Ventilator-associated 24 (18.5) 3 (11.1) 21 (20.4) 0.40

Table 1. Characteristics of adult patients with severe pneumonia caused by Corynebacterium striatum, Seoul, South Korea, 2014–2019*

*Values are no. (%) except as indicated. MRSA, methicillin-resistant Staphylococcus aureus.
†Patients could have ≥1 underlying disease or condition.
‡Defined as ≥1 of the following conditions: daily receipt of immunosuppressants, including corticosteroids; HIV infection; solid organ or hematopoietic stem cell transplant recipient; receipt of chemotherapy for underlying malignancy during the previous 6 months; or underlying immune deficiency disorder.

Table 2.  

Pathogens identified

No. (%) patients

p value*

2014–2015, n = 200

2016–2017, n = 180

2018–2019, n = 185

Total, n = 565

Total 88 (44.0) 66 (36.7) 75 (40.5) 229 (40.5) 0.35
Staphylococcus aureus 27 (13.5) 15 (8.3) 8 (4.3) 50 (8.8) <0.01
   Methicillin-susceptible 3 (1.5) 0 3 (1.6) 6 (1.1) 0.24
   Methicillin-resistant 24 (12.0) 15 (8.3) 5 (2.7) 44 (7.8) <0.01
Corynebacterium striatum 2 (1.0) 7 (3.9) 10 (5.4) 19 (3.4) 0.05
Streptococcus pneumoniae 4 (2.0) 2 (1.1) 1 (0.5) 7 (1.2) 0.43
Legionella pneumophila 1 (0.5) 1 (0.6) 0 2 (0.4) 0.61
Moraxella catarrhalis 0 0 1 (0.5) 1 (0.2) 0.36
Streptococcus pyogenes 0 1 (0.6) 0 1 (0.2) 0.34
Nocardia species 0 0 1 (0.5) 1 (0.2) 0.36
Enteric gram-negative bacilli 18 (9.0) 22 (12.2) 20 (10.8) 60 (10.6) 0.59
   Klebsiella pneumoniae 13 (6.5) 14 (7.8) 16 (8.6) 43 (7.6) 0.73
   Escherichia coli 4 (2.0) 4 (2.2) 3 (1.6) 11 (1.9) 0.92
   Enterobacter cloacae 1 (0.5) 3 (1.7) 2 (1.1) 6 (1.1) 0.54
   Citrobacter freundii 1 (0.5) 2 (1.1) 0 3 (0.5) 0.34
   Klebsiella oxytoca 0 0 2 (1.1) 2 (0.4) 0.13
   Hafnia alvei 0 0 1 (0.5) 1 (0.2) 0.36
Nonenteric gram-negative bacilli 47 (23.5) 22 (12.2) 37 (20.0) 106 (18.8) 0.02
   Acinetobacter baumannii 24 (12.0) 13 (7.2) 23 (12.4) 60 (10.6) 0.20
   Pseudomonas aeruginosa 19 (9.5) 6 (3.3) 11 (5.9) 36 (6.4) 0.047
   Stenotrophomonas maltophilia 4 (2.0) 2 (1.1) 7 (3.8) 13 (2.3) 0.22
   Burkholderia cepacia 0 0 1 (0.5) 1 (0.2) 0.36
   Acinetobacter lwoffii 0 1 (0.6) 0 1 (0.2) 0.34
   Chryseobacterium indologenes 0 1 (0.6) 0 1 (0.2) 0.34
   Chryseobacterium meningosepticum 1 (0.5) 0 0 1 (0.2) 0.40
   Chlamydia pneumoniae 1 (0.5) 0 0 1 (0.2) 0.40

Table 2. Bacterial pathogens detected among 565 adult patients with severe hospital-acquired pneumonia, Seoul, South Korea, 2014–2019

*p value based on χ2 test for trend.

Table 3.  

Pathogens

No. (%) co-infecting pathogens

p value*

Total, n = 130

C. striatum, n = 27

MRSA, n = 103

Any 50 (38.5) 13 (48.1) 37 (35.9) 0.25
Other bacteria 28 (21.5) 2 (7.4) 26 (25.2)† 0.045
   Pseudomonas aeruginosa 7 0 7  
   Acinetobacter baumannii 6 0 6  
   Klebsiella pneumoniae 5 0 5  
   Escherichia coli 4 1 3  
   Haemophilus influenzae 2 0 2  
   Streptococcus pneumoniae 2 0 2  
   Citrobacter freundii 1 0 1  
   Enterobacter cloacae 1 1 0  
   Elizabethkingia meningosepticum 1 0 1  
   Klebsiella aerogenes 1 0 1  
   Stenotrophomonas maltophilia 1 0 1  
Virus 24 (18.5) 9 (33.3)‡ 15 (14.6)§ 0.047
   Influenza virus 8 4 4  
      Influenza virus A 3 3 0  
      Influenza virus B 1 1 1  
   Parainfluenza virus type 3 4 1 3  
   Rhinovirus 3 1 2  
   Adenovirus 3 1 2  
   Respiratory syncytial virus 2 1 1  
      Respiratory syncytial virus A 1 1 0  
      Respiratory syncytial virus B 1 0 1  
   Human coronavirus 2 1 1  
      229E 1 1 0  
      OC43/HKU1 1 0 1  
   Human metapneumovirus 2 1 1  
   Bocavirus 1 0 1  
   Enterovirus 1 0 1  
Fungus 4 (3.1) 4 (14.8)¶ 0 <0.01
   Aspergillus species 4 (3.1) 4 (14.8) 0  
   Pneumocystis jirovecii 1 (0.8) 1 (3.7) 0  

Table 3. Additional pathogens detected among adult patients with severe Corynebacterium striatum pneumonia and methicillin-resistant Staphylococcus aureus pneumonia, Seoul, South Korea, 2014–2019*

*Categories of co-infection were not mutually exclusive; some cases were associated with ≥2 categories of pathogens.
†Three patients were co-infected with 2 bacteria: H. influenzae and S. pneumoniae; E. coli and K. pneumoniae; and A. baumannii and K. pneumoniae.
‡One patient was co-infected with influenza A virus and human metapneumovirus.
§One patient was co-infected with bocavirus and rhinovirus.
¶One patient was co-infected with Aspergillus species and P. jirovecii.

Table 4.  

Characteristics

Total, n = 130

C. striatum, n = 27

MRSA, n = 103

p value

Clinical manifestation
   Dyspnea 106 (81.5) 25 (92.6) 81 (78.6) 0.16
   Fever, temperature >38°C 103 (79.2) 18 (66.7) 85 (82.5) 0.07
   Sputum 92 (70.8) 16 (59.3) 76 (73.8) 0.14
   Cough 57 (43.8) 11 (40.7) 46 (44.7) 0.72
   Altered mental status 46 (35.4) 10 (37.0) 36 (35.0) 0.84
   Diarrhea 4 (3.1) 2 (7.4) 2 (1.9) 0.19
   Septic shock at ICU admission 81 (62.3) 12 (44.4) 69 (67.0) 0.03
   Mechanical ventilation 127 (97.7) 27 (100) 100 (97.1) 1.00
   APACHE II score, mean (SD) 25.6 (8.1) 26.4 (11.9) 26.0 (7.0) 0.72
   SOFA score, mean (SD) 9.5 (3.7) 9.5 (3.4) 9.5 (3.7) 0.99
   Bacteremia 19 (14.6) 1 (3.7) 18 (17.5) 0.12
Laboratory findings, median (IQR)
   Leukocyte count, cells/mL 10,950 (7,800–15,625) 11,600 (4,800–15,900) 10,700 (8,400–15,600) 0.26
   Platelets, × 103/mL 159 (81–242) 123 (55–230) 171 (102–245) 0.14
   C-reactive protein, mg/dL 11.3 (5.5–19.3) 13.6 (8.0–19.8) 10.8 (5.4–18.6) 0.61
   Procalcitonin, ng/mL 1.1 (0.3–3.9) 0.3 (0.1–1.3) 1.8 (0.4–4.2) <0.01

Table 4. Clinical and laboratory characteristics of patients with severe Corynebacterium striatum pneumonia and methicillin-resistant Staphylococcus aureus pneumonia, Seoul, South Korea, 2014–2019*

*Values are no. (%) except as indicated APACHE, acute physiology and chronic health evaluation; BAL, bronchoalveolar lavage; ICU, intensive care unit; IQR, interquartile range; MRSA, methicillin-resistant Staphylococcus aureus; SOFA, sequential organ failure assessment.

Table 5.  

Outcome

Total, n = 130

C. striatum, n = 27

MRSA, n = 103

p value

Death
Total n = 103 n = 27 n = 103 NA
   30 days 41 (31.5) 11 (40.7) 30 (29.1) 0.25
   60 days 57 (43.8) 14 (48.1) 44 (42.7) 0.61
   90 days 68 (52.3) 16 (59.3) 52 (50.5) 0.42
   In-hospital 73 (56.2) 19 (70.4) 54 (52.4) 0.09
Death among patient categories
   Nonimmunocompromised patients n = 89 n = 13 n = 76 NA
      30 days 21 (23.6) 5 (38.5) 16 (21.1) 0.18
      60 days 31 (34.8) 5 (38.5) 26 (34.2) 0.76
      90 days 40 (44.9) 7 (53.8) 33 (43.4) 0.49
      In-hospital 40 (44.9) 7 (53.8) 33 (43.4) 0.49
   Immunocompromised patients n = 41 n = 14 n = 27 NA
      30 days 20 (48.8) 6 (42.9) 14 (51.9) 0.59
      60 days 26 (63.4) 8 (57.1) 18 (66.7) 0.55
      90 days 28 (68.3) 9 (64.3) 19 (70.4) 0.73
      In-hospital 33 (80.5) 12 (85.7) 21 (77.8) 0.69
Median ICU stay, d (IQR) 14.0 (8.0–26.3) 14.0 (9.0–27.0) 14.0 (8.0–26.0) 0.33
Median hospital stay after ICU admission, d (IQR) 29.5 (14.0–57.0) 30.0 (16.0–81.0) 29.0 (14.0–55.0) 0.48

Table 5. Outcomes of adult patients with severe Corynebacterium striatum and methicillin-resistant Staphylococcus aureus pneumonia, Seoul, South Korea, 2014–2019*

*Values are no. (%) except as indicated. ICU, intensive care unit; MRSA, methicillin-resistant Staphylococcus aureus; NA, not applicable.

CME / ABIM MOC

Severe Pneumonia Caused by Corynebacterium striatum in Adults, Seoul, South Korea, 2014–2019

  • Authors: 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; Sang-Ho Choi, MD, PhD
  • CME / ABIM MOC Released: 10/19/2022
  • Valid for credit through: 10/19/2023, 11:59 PM EST
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for infectious disease clinicians, pulmonologists, internists, hospitalists, intensivists, and other clinicians who treat and manage patients with or at risk for severe Corynebacterium striatum pneumonia.

The goal of this activity is for learners to be better able to describe the proportion, clinical characteristics, and outcomes of severe Corynebacterium striatum hospital-acquired pneumonia (HAP) in adults compared with those of severe methicillin-resistant Staphylococcus aureus HAP, based on a retrospective study of 27 severe Corynebacterium striatum pneumonia cases during 2014 to 2019 in Seoul, South Korea.

Upon completion of this activity, participants will:

  • 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


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Yun Woo Lee, MD, MS

    Department of Infectious Diseases,
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Jin Won Huh, MD, PhD

    Department of Pulmonary and Critical Care Medicine
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Sang-Bum Hong, MD, PhD

    Department of Pulmonary and Critical Care Medicine
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Jiwon Jung, MD, PhD

    Department of Infectious Diseases
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Min Jae Kim, MD, PhD

    Department of Infectious Diseases
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Yong Pil Chong, MD, PhD

    Department of Infectious Diseases
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Sung-Han Kim, MD, PhD

    Department of Infectious Diseases
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Heungsup Sung, MD, PhD

    Department of Laboratory Medicine
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Kyung-Hyun Do, MD, PhD

    Department of Radiology
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Sang-Oh Lee, MD, PhD

    Department of Infectious Diseases
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Chae-Man Lim, MD, PhD

    Department of Pulmonary and Critical Care Medicine
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Yang Soo Kim, MD, PhD

    Department of Infectious Diseases
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Younsuck Koh, MD, PhD

    Department of Pulmonary and Critical Care Medicine
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

  • Sang-Ho Choi, MD, PhD

    Department of Infectious Diseases
    Asan Medical Center
    University of Ulsan College of Medicine
    Seoul, Republic of Korea

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie Inc.

Editor

  • Amy J. Guinn, BA, MA

    Copyeditor 
    Emerging Infectious Diseases

Compliance Reviewer

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.


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  • Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 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.

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CME / ABIM MOC

Severe Pneumonia Caused by Corynebacterium striatum in Adults, Seoul, South Korea, 2014–2019

Authors: 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; Sang-Ho Choi, MD, PhDFaculty and Disclosures

CME / ABIM MOC Released: 10/19/2022

Valid for credit through: 10/19/2023, 11:59 PM EST

processing....

Abstract and Introduction

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.

Introduction

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.