Epidemiological investigation of a nosocomial outbreak of multidrug-resistant Corynebacterium striatum at one Belgian university hospital

Abstract

During an 8-month period, 24 Corynebacterium striatum isolates recovered from lower respiratory tract specimens of 10 hospitalized patients were characterized. The organisms were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and by 16S rRNA gene sequencing. The cluster of C. striatum exclusively affected patients who had been admitted to an intensive care unit and/or subsequently transferred to one medium-size respiratory care unit. Prolonged duration of hospitalization, advanced stage of chronic obstructive pulmonary disease, recent administration of antibiotics and exposure to an invasive diagnostic procedure were the most commonly found risk factors in these patients. Seven patients were colonized and three infected. All strains displayed a similar broad spectrum resistance to antimicrobial agents, remaining susceptible to vancomycin only. Typing analysis by MALDI-TOF MS and by semi-automated repetitive sequence-based PCR (DiversiLab typing) showed that all outbreak-associated C. striatum isolates clustered together in one single type while they differed markedly from epidemiologically unrelated C. striatum isolates. Pulsed-field gel electrophoresis (PFGE) profiles revealed three distinct PFGE types among the C. striatum isolates associated with the outbreak while all external strains except one belonged to a distinct type. We conclude that C. striatum is an opportunistic nosocomial pathogen in long-term hospitalized patients and can be at the origin of major outbreaks. The routine use of MALDI-TOF MS greatly facilitated the recognition/identification of this organism in clinical samples and this technique could also offer the potential to be used as an easy and rapid epidemiological typing tool for outbreak investigation.

Matrix-assisted laser desorption ionization time-of-flight mass spectrometry: a powerful tool for identification of Corynebacterium species

“…Although the most widely known pathogenic species of Corynebacterium is C. diphtheriae, there was no C. diphtheria having been found. The dominant isolates in our study were C. striatum and C. jeikeium, which have also been reported as the cause of outbreaks of healthcare-associated infections, remarkably (13)(14)(15)(16) Alibi et al (17), our data show a lower agreement (65.3%) between two methods. Twenty-six strains showed unreliable or ambiguous API results and were only identified to genus level (Corynebacterium spp.).…”

Characteristics of Multidrug-Resistant <i>Corynebacterium</i> spp. Isolated from Blood Cultures of Hospitalized Patients in Japan

“…Drugresistant Corynebacterium spp. strains were suggested to be an emerging opportunistic nosocomial pathogen in long-term hospitalized patients and can be the origin of major outbreaks (15,16). Furthermore, Corynebacterium striatum was reported as an emerging pathogen in both immunocompetent and immunocompromised hosts (17).…”

Rapid transmission of multidrug-resistant Corynebacterium striatum among susceptible patients in a tertiary hospital in China

“…In recent years, C. striatum has been found to be a potentially important bacterial pathogen for humans, since it has been isolated from several kinds of sterile samples, including cerebral fluid, arthroedema, and others [2][3][4][5][6]. However, most of the C. striatum strains reported were isolated from the lower respiratory tracts of patients with chronic obstructive pulmonary diseases as well as other specific risk factors [7][8][9]. The other well-known risk factors include a longer hospitalization period and previous use of betalactam antibiotics and invasive devices for diagnosis and treatment [7][8][9].…”

“…However, most of the C. striatum strains reported were isolated from the lower respiratory tracts of patients with chronic obstructive pulmonary diseases as well as other specific risk factors [7][8][9]. The other well-known risk factors include a longer hospitalization period and previous use of betalactam antibiotics and invasive devices for diagnosis and treatment [7][8][9]. Furthermore, most of the C. striatum strains reported show multidrug-resistant phenotypes [6][7][8][9].…”