Do patients with Corynebacterium urelyticum infections require isolation precautions?

Contact Precautions Are Required for Patients with Corynebacterium urealyticum Infections

Patients with Corynebacterium urealyticum infections should be placed on contact precautions to prevent transmission in healthcare settings. 1

Rationale for Contact Precautions

Corynebacterium urealyticum is a multidrug-resistant organism (MDRO) with several concerning characteristics:

• High rates of multidrug resistance (97.5% of isolates) 2
• Resistance to multiple antibiotic classes including ampicillin (100%), erythromycin (95%), and fluoroquinolones (95%) 2
• Ability to cause persistent urinary tract infections, particularly in hospitalized patients 3
• Association with alkaline-encrusted cystitis and struvite stone formation 4

Implementation of Contact Precautions

When managing patients with C. urealyticum infections, the following infection control measures should be implemented:

Patient Placement

• Place infected patients in private rooms when possible
• If private rooms are unavailable, cohort patients with the same organism together 1
• Priority for single room isolation should be given to patients with:
  • Fecal or urinary incontinence
  • Use of invasive devices/equipment
  • Continuous wound secretion 1

Personal Protective Equipment

• Wear clean, non-sterile gloves when entering the patient's room 1
• Change gloves after contact with material containing high concentrations of bacteria
• Wear a clean, non-sterile gown when:
  • Substantial contact with the patient is anticipated
  • Contact with environmental surfaces is likely
  • The patient is incontinent or has uncontained drainage 1
• Remove gloves and gown before leaving the patient's room 1

Hand Hygiene

• Perform hand hygiene with an antiseptic soap or waterless antiseptic agent immediately after removing gloves 1
• Standard alcohol-based hand rubs are effective when hands are not visibly soiled 5
• Ensure proper technique: apply enough product to cover all hand surfaces and rub hands together until dry 5

Equipment and Environmental Cleaning

• Dedicate non-critical items (e.g., stethoscope, blood pressure cuff) to a single patient or cohort of patients 1
• If equipment must be shared, thoroughly clean and disinfect between patients 1, 5
• Pay special attention to high-touch surfaces in patient care areas 5
• Use EPA-registered disinfectants appropriate for the surface 5

Surveillance and Monitoring

For healthcare facilities with C. urealyticum cases:

• Consider screening roommates of newly identified cases 1
• Establish a system for flagging medical records of infected patients for future admissions 1
• Monitor compliance with infection control measures 1

Discontinuation of Precautions

• Adopt stringent criteria for discontinuing isolation precautions
• Consider requiring multiple negative cultures (at least three consecutive negative results from multiple body sites) before discontinuing precautions 1, 5
• Be aware that colonization can persist indefinitely 1

Pitfalls and Caveats

• C. urealyticum may be misidentified by conventional laboratory methods 6
• The organism grows slowly and may be missed in routine urine cultures without extended incubation 4
• Selective media may increase detection rates but is not cost-effective for routine use 7
• Inadequate hand hygiene is the most common cause of healthcare-associated infections 5
• Compliance with contact precautions often decreases over time, requiring ongoing education and monitoring

By implementing these contact precautions, healthcare facilities can reduce the risk of C. urealyticum transmission and prevent outbreaks of this multidrug-resistant pathogen.