What is the treatment for Corynebacterium jeikeium infections?

Treatment of Corynebacterium jeikeium Infections

Vancomycin is the first-line treatment for Corynebacterium jeikeium infections due to the organism's characteristic multidrug resistance pattern. 1

Microbiology and Clinical Significance

C. jeikeium is a gram-positive, aerobic, pleomorphic bacillus that is part of the normal skin flora but can cause serious opportunistic infections, particularly in:

• Immunocompromised patients, especially those with hematologic malignancies 2
• Patients with prosthetic devices, particularly cardiac prostheses 1
• Individuals with prolonged hospitalization receiving broad-spectrum antibiotics 3
• Hemodialysis patients 4

C. jeikeium is characterized by its multidrug resistance pattern, typically showing resistance to penicillins, cephalosporins, aminoglycosides, with variable sensitivity to quinolones, macrolides, tetracyclines, and rifampin 5.

Treatment Recommendations

First-line Treatment:

• Vancomycin is the treatment of choice for C. jeikeium infections 1
  • Standard dosing: 15-20 mg/kg IV every 8-12 hours (adjusted based on renal function)
  • Target trough levels: 15-20 μg/mL for serious infections

Alternative Treatments:

• Daptomycin has demonstrated in vitro activity against C. jeikeium 6

  • Dosing: 6-10 mg/kg IV once daily (higher doses for serious infections)
  • Particularly useful for bloodstream infections and endocarditis

• Linezolid may be considered as an alternative

  • Dosing: 600 mg IV/PO every 12 hours

For Central Venous Catheter-Related Infections:

• For clinically stable patients with C. jeikeium catheter-related infections, catheter preservation may be initially attempted 1
• However, if the patient shows signs of clinical deterioration or persistent bacteremia, prompt catheter removal is recommended
• At least 2 weeks of systemic antimicrobial treatment is recommended in immunocompromised patients 1
• An antimicrobial-lock technique may be an option for "highly needed" infected catheters that cannot be removed 1

Special Considerations

Endocarditis:

• C. jeikeium endocarditis has a high mortality rate (up to 33%) despite treatment 5
• More likely to require valve replacement compared to other Corynebacterium species endocarditis 5
• Extended treatment course (minimum 4-6 weeks) is typically required

Immunocompromised Patients:

• More aggressive treatment approach is warranted
• Consider combination therapy in severe cases
• Longer duration of treatment may be necessary

Prosthetic Device Infections:

• Often requires device removal in addition to antimicrobial therapy
• If device cannot be removed, consider long-term suppressive therapy

Monitoring and Duration

• Regular monitoring of clinical response and follow-up blood cultures to document clearance of bacteremia
• Duration of therapy depends on the site and severity of infection:
  • Uncomplicated bacteremia: 10-14 days
  • Endocarditis: minimum 4-6 weeks
  • Prosthetic device infections: 6 weeks or longer

Common Pitfalls

1. Misidentification as a contaminant: C. jeikeium is often mistakenly dismissed as a skin contaminant in blood cultures, delaying appropriate treatment 4

2. Inadequate empiric coverage: Standard empiric regimens for fever in immunocompromised patients may not cover C. jeikeium

3. Failure to remove infected devices: Retention of infected catheters or prosthetic devices often leads to treatment failure

4. Insufficient treatment duration: Short courses of antibiotics are associated with relapse, particularly in endocarditis and device-related infections

By recognizing the clinical significance of C. jeikeium isolates and promptly initiating appropriate antimicrobial therapy, outcomes can be improved in these challenging infections.