Bone and Joint Infection Involving Corynebacterium spp.: From Clinical Features to Pathophysiological Pathways

Abstract

Introduction: Corynebacteria represent often-neglected etiological agents of post-traumatic and/or post-operative bone and joint infection (BJI). We describe here clinical characteristics and bacteriological determinants of this condition.Methods: A retrospective cohort study described characteristics, outcome and determinants of treatment failure of all patients with proven Corynebacterium spp. BJI (i.e., ≥2 culture-positive gold-standard samples). Available strains were further characterized regarding their antibiotic susceptibilies, abilities to form early (BioFilm Ring Test®) and mature (crystal violet staining method) biofilms and to invade osteoblasts (gentamicin protection assay).Results: The 51 included BJI were mostly chronic (88.2%), orthopedic device-related (74.5%) and polymicrobial (78.4%). After a follow-up of 60.7 weeks (IQR, 30.1–115.1), 20 (39.2%) treatment failures were observed, including 4 Corynebacterium-documented relapses, mostly associated with non-optimal surgical management (OR 7.291; p = 0.039). Internalization rate within MG63 human osteoblasts was higher for strains isolated from delayed (>3 months) BJI (p < 0.001). Infection of murine osteoblasts deleted for the β1-integrin resulted in a drastic reduction in the internalization rate. No difference was observed regarding biofilm formation.Conclusions: Surgical management plays a crucial role in outcome of BJI involving corynebacteria, as often chronic and device-associated infections. Sanctuarisation within osteoblasts, implicating the β1 cellular integrin, may represent a pivotal virulence factor associated with BJI chronicity.

Multiresistance and endemic status of Corynebacterium striatum associated with nosocomial infections: a critical situation in Intensive Care Units and varied wards of a tertiary care hospital, Rio de Janeiro metropolitan area, Brazil

“…33 Nowadays, the risk of pneumonia is increased in the intubated patients receiving mechanical ventilation and the ventilator associated pneumonia nosocomial pneumonia due to mechanical ventilation procedures in mechanically ventilated patients is a matter of concern world wild, including Brazil. 34 Remarkably, current findings also indicated ventilator support as a risk factor for acquiring C. striatum infection. Therefore, C. striatum strains, especially when expressing MDR profiles, should be considered as clinically relevant when isolated in pure culture, and/or predominantly from patients with hospital acquired infections in the respiratory tract and/ or ventilator-associated pneumonia, as previously reported for Corynebacterium spp.…”

Clinical Profile of Monomicrobial Corynebacterium Hip and Knee Periprosthetic Joint Infections

“…We highlight several important observations on monomicrobial Corynebacterium PJI in our study. Our findings can be compared with prior series while keeping in mind that earlier publications included polymicrobial infections; hence, other pathogens might have altered the clinical course in these studies and may account for some differences in observations [ 9 , 11–13 ].…”

“…Symptoms were considered acute if present for ≤4 weeks and chronic if present for >4 weeks [ 9 ]. PJI was considered early if it occurred <3 months, delayed if occurred within 3–12 months, and late if occurred >12 months from last arthroplasty or revision [ 10 ].…”

Relapsed boyhood tibia polymicrobial osteomyelitis linked to dermatophytosis: a case report

“…However, polymicrobial bone infection of S. aureus with Corynebacterium has yet to be documented. Corynebacterium species are gram-positive, catalase-positive, aerobic or facultatively anaerobic microorganisms of the human skin and mucous membranes that were originally thought to be contaminants, but are now recognized as pathogenic species [ 18 ]. A few cases were reported as Corynebacterium relapses of prosthetic joint infections (PJIs), which were mostly associated with non-optimal surgical management, and only one case of Corynebacterium osteomyelitis in an immunocompromised child was reported [ 19 , 20 ].…”