P-907. Management of Corynebacterium striatum Deep-Seated Infections Across the Veterans Affairs Health Care System

TL;DR

This study examines the best treatments for deep infections caused by Corynebacterium striatum in veterans, finding that reliable antibiotics reduce treatment failure.

Contribution

The study provides evidence that using antibiotics with reliable activity against C. striatum improves clinical outcomes in deep-seated infections.

Findings

Treatment with reliable antibiotics (e.g., vancomycin) was associated with significantly lower treatment failure rates.

Cohorts receiving variable or no activity antibiotics had higher failure rates compared to the reliable antibiotic group.

Surgical source control with short-term antibiotics also showed high treatment failure rates.

Abstract

Corynebacterium striatum is frequently isolated from deep tissue cultures, yet its clinical significance and optimal treatment remain uncertain.

This was a retrospective cohort study of all patients in the Veterans Affairs Health Care System treated for C.striatum or non-speciated Corynebacterium isolated from ≥ 1 deep tissue culture between 1 January 2013 and 30 September 2022. Patients were assigned to 1 of 4 cohorts: 1) > 7 days treatment with a reliable agent (vancomycin, linezolid, tedizolid, lipoglycopeptide), 2) > 7 days treatment with an agent possessing variable activity (daptomycin, aminopenicillins [±β-lactamase inhibitor], doxycycline, minocycline, sulfamethoxazole-trimethoprim), 3) > 7 days treatment of an agent with no activity (all other antibiotics), and 4) definitive surgical source control with ≤ 7 days of antibiotics. The primary composite outcome was clinical failure, defined as microbiologic recurrence or antibiotic failure within 6 months, unplanned surgical procedure within 12 months, or 12-month all-cause mortality.

A total of 120 patients met inclusion criteria. Notable differences in baseline characteristics were ID consultation (94.9%, 82.1%, 77.3%, 40%), polymicrobial infection (56.4%, 76.9%, 54.5%, 45%), and C.striatum isolated (76.9%, 89.7%, 86.4%, 90%) in cohorts 1-4, respectively. Vancomycin was the most used antibiotic in cohort 1 at 82.1% followed by linezolid at 25.6%. Aminopenicillins (±β-lactamase inhibitor) were the most used antibiotic in cohort 2 at 41% followed by daptomycin at 35.9%.

Treatment failure occurred in 33.3% (13/39), 61.5% (24/39), 45.5% (10/22), and 65% (13/20) of patients in cohorts 1-4, respectively (p=0.018). When directly comparing cohort 1 against each individual cohort, treatment failure was significantly higher in cohorts 2 and 4 (p=0.019 and p=0.008, respectively). Multivariable analysis revealed receipt of a cohort 1 antibiotic was independently associated with a lower odds of treatment failure (OR 0.19, 95% 0.052-0.693). No other factors tested were associated with treatment failure.

For deep-seated C.striatum and non-speciated Corynebacterium infections, treatment with reliable antibiotics was significantly associated with reduced risk of treatment failure.

All Authors: No reported disclosures