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Corynebacterium Species Rarely Cause Orthopedic Infections Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2018 Corynebacterium species rarely cause orthopedic infections Kalt, Fabian ; Schulthess, Bettina ; Sidler, Fabian ; Herren, Sebastian ; Fucentese, Sandro F ; Zingg, Patrick O ; Berli, Martin ; Zinkernagel, Annelies S ; Zbinden, Reinhard ; Achermann, Yvonne Abstract: Corynebacterium spp. are rarely considered as pathogens but data in orthopedic infections are sparse. Therefore, we asked how often Corynebacterium spp. caused an infection in a defined cohort of orthopedic patients with a positive culture. In addition, we aimed to determine the species variety and susceptibility of isolated strains in regards to potential treatment strategies. Between 2006 and 2015, we retrospectively assessed all Corynebacterium sp. bone and joint cultures from an orthopedic ward. The isolates were considered as relevant indicating an infection if the same Corynebacterium sp. was present in at least two samples. We found 97 orthopedic cases with isolation of Corynebacterium spp. (128 positive samples), mainly Corynebacterium tuberculostearicum (n=26), Corynebacterium amycolatum (n=17), Corynebacterium striatum (n=13), and Corynebacterium afermentans (n=11). Compared to a cohort of positive blood cultures, we found significantly more C. striatum and C. tuberculostearicum but no C. jeikeium cases. Only 16 cases out 66 cases (24.2%) with an available diagnostic set of at least 2 samples had an infection. Antibiotic susceptibility testing (AST) of different antibiotics showed various susceptibility results except for vancomycin and linezolid with a 100% susceptibility rate. Rates of susceptibility of corynebacteria isolated from orthopedic samples and of isolates from blood cultures were comparable. In conclusion, our study results confirmed that Corynebacterium sp. is most often isolated as a contaminant in a cohort of orthopedic patients. AST is necessary to define the optimal treatment in orthopedic infections. DOI: https://doi.org/10.1128/JCM.01200-18 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-157366 Journal Article Published Version Originally published at: Kalt, Fabian; Schulthess, Bettina; Sidler, Fabian; Herren, Sebastian; Fucentese, Sandro F; Zingg, Patrick O; Berli, Martin; Zinkernagel, Annelies S; Zbinden, Reinhard; Achermann, Yvonne (2018). Corynebac- terium species rarely cause orthopedic infections. Journal of Clinical Microbiology, 56(12):e01200-18. DOI: https://doi.org/10.1128/JCM.01200-18 JCM Accepted Manuscript Posted Online 10 October 2018 J. Clin. Microbiol. doi:10.1128/JCM.01200-18 Copyright © 2018 American Society for Microbiology. All Rights Reserved. 1 Corynebacterium species rarely cause orthopedic infections 2 Fabian Kalta*, Bettina Schulthessc*, Fabian Sidlera, Sebastian Herrenc, Sandro F. 3 Fucenteseb, Patrick O. Zinggb, Martin Berlib, Annelies S. Zinkernagela, Reinhard 4 Zbindenc●, Yvonne Achermanna● 5 Downloaded from 6 Division of Infectious Diseases and Hospital Epidemiology, University Hospital 7 Zurich, University of Zurich, Zurich, Switzerlanda 8 Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, 9 Switzerlandb http://jcm.asm.org/ 10 Institute of Medical Microbiology, University of Zurich, Zurich, Switzerlandc 11 ● contributed equally to this work 12 * contributed equally to this work 13 14 Running Head: Corynebacterium species in orthopedic infections on October 25, 2018 by guest 15 16 Corresponding address: 17 Yvonne Achermann, MD 18 Division of Infectious Diseases and Hospital Epidemiology 19 University Hospital Zurich, University of Zurich 20 Raemistrasse 100 21 CH-8091 Zurich, Switzerland 22 Phone: + 41 44 255 21 73; Fax: + 41 44 255 44 99 23 Email: [email protected] 1 24 ABSTRACT 25 Corynebacterium spp. are rarely considered as pathogens but data in orthopedic 26 infections are sparse. Therefore, we asked how often Corynebacterium spp. caused 27 an infection in a defined cohort of orthopedic patients with a positive culture. In 28 addition, we aimed to determine the species variety and susceptibility of isolated Downloaded from 29 strains in regards to potential treatment strategies. Between 2006 and 2015, we 30 retrospectively assessed all Corynebacterium sp. bone and joint cultures from an 31 orthopedic ward. The isolates were considered as relevant indicating an infection if 32 the same Corynebacterium sp. was present in at least two samples. We found 97 http://jcm.asm.org/ 33 orthopedic cases with isolation of Corynebacterium spp. (128 positive samples), 34 mainly Corynebacterium tuberculostearicum (n=26), Corynebacterium amycolatum 35 (n=17), Corynebacterium striatum (n=13), and Corynebacterium afermentans (n=11). 36 Compared to a cohort of positive blood cultures, we found significantly more C. on October 25, 2018 by guest 37 striatum and C. tuberculostearicum but no C. jeikeium cases. Only 16 cases out 66 38 cases (24.2%) with an available diagnostic set of at least 2 samples had an infection. 39 Antibiotic susceptibility testing (AST) of different antibiotics showed various 40 susceptibility results except for vancomycin and linezolid with a 100% susceptibility 41 rate. Rates of susceptibility of corynebacteria isolated from orthopedic samples and 42 of isolates from blood cultures were comparable. In conclusion, our study results 43 confirmed that Corynebacterium sp. is most often isolated as a contaminant in a 44 cohort of orthopedic patients. AST is necessary to define the optimal treatment in 45 orthopedic infections. 2 46 INTRODUCTION 47 Orthopedic infections, including septic arthritis of a native joint, periprosthetic joint 48 infections (PJI), and osteomyelitis, are typically treated in specialized orthopedic 49 centers. Most of these infections are chronic, and they are difficult to diagnose and to 50 treat due to biofilm formation (1). A definitive criterion for orthopedic infections is Downloaded from 51 growth of the same pathogen in at least two diagnostic samples or presence of a 52 sinus tract in implant-associated infections (2, 3). The significance of a single 53 positive sample of skin commensals such as coagulase-negative staphylococci, 54 Cutibacterium species (formerly Propionibacterium species) species, or http://jcm.asm.org/ 55 Corynebacterium species is not fully clear and often considered a contamination of 56 the sample. 57 The spectrum of human infections with corynebacteria is broad ranging from 58 community-acquired infections such as conjunctivitis, pharyngitis, genitourinary tract on October 25, 2018 by guest 59 infections, prostatitis, skin and soft-tissue infections, and breast abscess to 60 nosocomial acquired infections such as cerebrospinal fluid shunt infections, 61 pneumonia, intravenous catheter-related bloodstream infections, endocarditis, 62 postsurgical infections, urinary tract infections, and peritoneal dialysis-related 63 peritonitis (4-12). The spectrum of Corynebacterium spp. orthopedic infections has 64 not been described so far. In this study, we report the spectrum of Corynebacterium 65 spp. isolates of suspected orthopedic infections and compare it with the spectrum of 66 species isolated from patients with suspected blood-stream infections. We 67 discriminated between infections and contaminants based on clinical and 3 68 microbiological criteria and present antibiotic susceptibility data to describe treatment 69 options. Downloaded from http://jcm.asm.org/ on October 25, 2018 by guest 4 70 METHODS 71 Orthopedic study population 72 The orthopedic University Hospital Balgrist in Zurich, Switzerland is a 140-bed 73 orthopedic center. Approximately 5000 orthopedic procedures are performed 74 annually. In this single-center study, we retrospectively identified patients with at Downloaded from 75 least one culture positive sample with Corynebacterium spp. derived from synovial 76 fluid, deep tissue/bone, or sonication fluid from removed implants between January 77 2006 and December 2015. Bacteria labeled as “coryneform bacteria”, i.e., aerobic 78 Actinomyces spp., Brevibacterium spp., Dermabacter hominis, Lactobacillus spp., http://jcm.asm.org/ 79 Cutibacterium (Propionibacterium) spp., and other Gram-positive rods, which were 80 not further characterized, were excluded from our analysis. The latter were found 81 only in single samples in a small amount or in mixed cultures. Cases with lack of 82 clinical data were excluded for our investigation (Figure 1). on October 25, 2018 by guest 83 Species variation of Corynebacterium spp. in suspected orthopedic infections 84 compared to blood-stream infections outside orthopedic wards. We compared 85 the various isolated Corynebacterium spp. from orthopedic origins with isolates 86 recovered from blood cultures (from January 2006 to December 2015) in patients 87 with suspected bloodstream infections hospitalized in non-orthopedic wards of the 88 University Hospital of Zurich, Switzerland, with a wide range of medical specialties 89 (e.g., ophthalmology, urology, gynecology, neurosurgery, vascular and heart 90 surgery, dermatology, internal medicine, oncology). 91 Clinical diagnosis. All samples of the same patient, the same hospitalization period, 92 and the same infection site were considered as one diagnostic set. The number of 5 93 samples with Corynebacterium spp., sample type, and the results of antibiotic 94 susceptibility testing (AST) were analyzed using the database
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