What is the recommended treatment for Corynebacterium striatum infections, particularly in immunocompromised patients or those with severe infections and impaired renal function?

Treatment of Corynebacterium striatum Infections

Vancomycin is the first-line antibiotic for C. striatum infections, particularly in severe cases, immunocompromised patients, or when multidrug resistance is suspected. 1, 2

Initial Antibiotic Selection

• Vancomycin should be initiated empirically for serious C. striatum infections before susceptibility results are available, as this organism frequently exhibits multidrug resistance 3, 4, 5
• All tested C. striatum strains in one bacteremia series were susceptible only to vancomycin, with the majority being multidrug resistant 6
• The Infectious Diseases Society of America recommends vancomycin as first-line therapy for severe infections or multidrug-resistant strains 1, 2

Treatment Duration and Monitoring

• Administer therapy for 7-14 days for most serious infections, with extension beyond 14 days if endovascular infection or metastatic infection is present 1
• For catheter-related C. striatum infections, treat with appropriate systemic antibiotics for 10-14 days 2
• In one peritoneal dialysis catheter exit site infection, successful treatment was achieved with vancomycin 1 g intravenously administered at 5-day intervals for 1 month 3

Device Management

• Catheter removal is recommended when possible for catheter-related infections, particularly with clinical deterioration, persisting bacteremia, or suppurative complications 7, 2
• However, catheter retention with antibiotic therapy can be successful in selected cases, as demonstrated in the peritoneal dialysis patient who achieved cure without catheter removal 3

Combination Therapy Considerations

• Vancomycin plus rifampin combination may be considered for severe infections, particularly pneumonia in immunocompromised hosts 4
• One heart transplant recipient with multidrug-resistant C. striatum pneumonia resolved with 4 weeks of vancomycin therapy combined with rifampin during the first 2 weeks 4

Alternative Agents for Susceptible Strains

• Amoxicillin-rifampin combination may be effective when aminopenicillin susceptibility is confirmed, particularly for bone and joint infections 8
• In a cohort of 12 bone and joint infections, 10/12 strains were susceptible to aminopenicillin, and 8/12 patients treated with amoxicillin-rifampin achieved cure 8
• Linezolid has been used successfully in isolated cases, such as pancreatic abscess 5

Dosing Adjustments in Renal Impairment

For patients with severe renal impairment (creatinine clearance <30 mL/min), vancomycin dosing requires adjustment due to significantly altered pharmacokinetics 9

• Mean AUC for patients with creatinine clearance <30 mL/min is approximately 2-3 times higher than for patients with normal renal function 9
• Therapeutic drug monitoring should be performed when using vancomycin or aminoglycosides 2
• Extended dosing intervals (such as every 5 days) may be appropriate in dialysis patients, as demonstrated in the peritoneal dialysis case 3

Clinical Recognition and Diagnosis

C. striatum should be considered a true pathogen rather than a contaminant when:

• Isolated in pure culture with clinical signs of infection 3
• Gram-positive rods are abundant on direct Gram stain with leukocyte reaction 3
• Patient has risk factors including immunocompromise, indwelling medical devices, or previous antibiotic exposure 3, 4, 5
• Malignancy and neutropenia significantly increase the odds of true C. striatum bloodstream infection 6

Common Pitfalls to Avoid

• Do not dismiss C. striatum as a contaminant when isolated from blood or sterile sites, particularly in immunocompromised patients or those with devices 2, 3, 6
• Always perform susceptibility testing on clinically significant isolates, as resistance patterns are highly variable and multidrug resistance is common 3, 4, 6
• Do not delay vancomycin initiation while awaiting susceptibility results in severe infections, as empiric coverage with other agents may be inadequate 4, 5
• Recognize that aminopenicillin susceptibility testing is not routinely recommended by EUCAST/CASFM guidelines but may identify effective treatment options 8