From the Guidelines
Corynebacterium striatum in a urine culture does not necessarily require antibiotic treatment, especially in asymptomatic patients, due to the potential harm of antibiotics and the lack of evidence showing benefit in preventing symptomatic UTI or renal complications. When considering treatment, several factors come into play, including the presence of symptoms, the colony count, and whether the bacterium represents a true infection or contamination. According to the clinical practice guideline for the management of asymptomatic bacteriuria by the Infectious Diseases Society of America 1, there is moderate-quality evidence that there is no benefit and high-quality evidence of harm in treating asymptomatic bacteriuria (ASB).
Key Considerations
- Symptomatic vs. Asymptomatic Infection: If the patient has urinary symptoms (such as burning, frequency, urgency) and a significant colony count (>10^5 CFU/mL), treatment is typically warranted. However, for asymptomatic patients, the guideline recommends against treatment due to the lack of benefit and the potential for harm, including adverse effects, increased costs, and contribution to antimicrobial resistance 1.
- Antibiotic Resistance: Corynebacterium striatum is known to be resistant to many common antibiotics, making antibiotic susceptibility testing crucial for guiding therapy. Appropriate antibiotics may include vancomycin, linezolid, or daptomycin, but the choice should be based on susceptibility testing results.
- Catheter Removal: For patients with urinary catheters, removal of the catheter is an important part of management, as it can help prevent further infection and reduce the risk of antimicrobial resistance.
Management Approach
- For symptomatic infections with significant colony counts, consider antibiotic treatment based on susceptibility testing.
- For asymptomatic patients, avoid antibiotic treatment due to the potential for harm and lack of benefit.
- Always consider removal of urinary catheters when present, as part of the management strategy.
- Be cautious of the potential for antimicrobial resistance, especially in patients with chronic indwelling catheters or those who have received previous antibiotic treatments.
From the Research
Corynebacterium Striatum Infections
- Corynebacterium striatum is an emerging nosocomial pathogen that can cause various infections, including urinary tract infections 2.
- Infections with C. striatum tend to be more frequent in males and are often associated with medical devices such as intravascular catheters 3.
Antibiotic Treatment
- The antibiotic treatment of C. striatum infections is crucial, and vancomycin is recommended as the first-line treatment 4.
- Other effective antibiotics against C. striatum include linezolid, teicoplanin, piperacillin-tazobactam, amoxicillin-clavulanate, and cefuroxime 4, 5.
- However, some strains of C. striatum have shown resistance to fluoroquinolones, β-lactams, aminoglycosides, macrolides, lincosamides, and cotrimoxazole 4, 5.
Urine Culture Results
- If Corynebacterium striatum is identified in urine culture results, it is essential to consider the patient's clinical presentation and medical history to determine the appropriate course of treatment 6, 2.
- In some cases, C. striatum may be considered a contaminant, but it can also be a causative agent of infection, particularly in immunocompromised or hospitalized patients 2, 3.