Characterization and antimicrobial susceptibility of one antibiotic-sensitive and one multidrug-resistant Corynebacterium kroppenstedtii strain isolated from patients with granulomatous mastitis

Abstract

Human infections associated with Corynebacterium kroppenstedtii are rarely reported, and this organism is usually described as antibiotic sensitive. Almost all published cases of C. kroppenstedtii infections have been associated with breast pathology in women and have been described in New Zealand, France, Canada, India and Japan. Here we describe the microbiologic characteristics of two strains isolated from two women diagnosed of granulomatous mastitis in Spain. One C. kroppenstedtii isolate was antibiotic sensitive while the other was multidrug resistant. Biochemical identification was possible using a wide battery of methods including API Coryne V2.0, API Strep, API NH, API NE, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA gene amplification and sequencing. Antimicrobial susceptibility to 28 antibiotics as determined by Etest showed one isolate being sensitive to benzylpenicillin, ciprofloxacin, moxifloxacin, gentamicin, vancomycin, clindamycin, tetracycline, linezolid and rifampin. The second isolate showed resistance to ciprofloxacin, moxifloxacin, clindamycin, tetracycline and rifampin. The multidrug-resistant isolate contained the erm(X), tet(W), cmx, aphA1-IAB, strAB and sul1 resistance genes known from the R plasmid pJA144188 of Corynebacterium resistens. These genes were absent in the genome of the antibiotic-sensitive isolate. This report confirms the tropism of this microorganism for women's breasts and presents the first description of a multidrug-resistant C. kroppenstedtii strain.

Pathogens in patients with granulomatous lobular mastitis

“…The pathogens in patients with GLM have not yet been fully clarified. Previous studies have suggested that C. kroppenstedtii is the main pathogen of GLM (Yu et al, 2016;Fernández-Natal et al, 2016;Johnstone et al, 2017). In the present study, the initial data showed the presence of the C. kroppenstedtii sequence in 14 of the 40 patients (35%).…”

Cystic neutrophilic granulomatous mastitis: The Cleveland Clinic experience with diagnosis and management

“…In ideal settings, targeted antimicrobial therapies are based upon accurate microbiologic identification and susceptibility testing. While Corynebacterium kroppenstedtii organisms are often susceptible to antibiotics, multidrug resistant strains are known to exist and have been confirmed in some instances of granulomatous mastitis . For patients in which empiric therapy is started or for whom resistant organisms are confirmed, other treatment options such as corticosteroid therapy and surgery may be implemented with debridement, incision, and drainage, or excision sometimes being necessary for larger abscess cavities …”

“…Cross-disciplinary communication between primary care providers, surgeons, breast imagers, infectious disease consultants, anatomic pathologists, and medical microbiologists may increase awareness and have the potential to result in better management algorithms. [13][14][15] Management 16 For patients in which empiric therapy is started or for whom resistant organisms are confirmed, other treatment options such as corticosteroid therapy and surgery may be implemented with debridement, incision, and drainage, or excision sometimes being necessary for larger abscess cavities. 3,5,13 While all of the information presented in this retrospective case series is accurate, we recognize that our study design has limitations, Increased communication could afford the use of media supplemented with Tween to enhance the recovery of these fastidious pathogens.…”

Corynebacterium kroppenstedtii in granulomatous mastitis: Analysis of formalin‐fixed, paraffin‐embedded biopsy specimens by immunostaining using low‐specificity bacterial antisera and real‐time polymerase chain reaction

“…Reportedly, non‐kroppenstedtii Corynebacterium , particularly C. tuberculostearicum , isolated from GM lesions is multidrug‐resistant, and C. kroppenstedtii may occasionally resist antimicrobial treatment . The presence of drug resistance genes can be proven in the bacterial isolates by next‐generation DNA sequencing technologies such as matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF MS) and 16S ribosomal RNA gene sequencing …”

“…25 The presence of drug resistance genes can be proven in the bacterial isolates by next-generation DNA sequencing technologies such as matrix-assisted laser desorption/ionization time-offlight mass spectrometry (MALDI-TOF MS) and 16S ribosomal RNA gene sequencing. [24][25][26] By the real-time PCR analysis using the common primer set, Propionibacterium acnes (Pac) DNA and the common DNA sequence of Nocardia and Mycobacteria, Rhodococcus, Gordonia and Dietzia species were detected instead of Ck in a total of three GM lesions. Nocardia induces mastitis in cattle.…”