Friday, September 22, 2023
|
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.
|
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.
|
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.
|
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.
|
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.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 1.00 ABIM MOC points
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.
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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.
