Endocarditis due to Corynebacterium amycolatum

Abstract

Corynebacterium amycolatum, a normal inhabitant of human skin, is a Gram-positive, non-sporeforming, mycolic acid-free, aerobic or facultative anaerobic bacillus. Since its description in 1988, it has only rarely been associated with infective endocarditis. This paper describes a case of infective endocarditis successfully treated by combination therapy with daptomycin and rifampicin. To the best of our knowledge, this is the first case report of C. amycolatum endocarditis from the USA successfully treated with these agents. Case reportThe patient was an 84-year-old female resident in a longterm care facility with end-stage renal disease requiring haemodialysis three times a week via a left subclavian haemodialysis catheter, and with atherosclerotic heart disease, hypertension and congestive heart failure. The patient was referred to our hospital from a dialysis centre with fever and hypotension. On physical examination, her blood pressure was 92/78 mmHg, her temperature was 39.8 u C and a new loud cardiac murmur localized in the mitral area was evident. No peripheral stigmata of endocarditis were present.Initial blood work showed 17 800 leukocytes ml 21 (84 % neutrophils, 16 % lymphocytes), and blood cultures performed at admission resulted in the growth of Gram-positive rods within 24 h in all four bottles. These were later identified as Corynebacterium amycolatum using the API Coryne database 2.0 (bioMérieux). Susceptibility by Etest gave the following MICs (mg ml 21 ): penicillin, 16; ampicillin, 32; erythromycin, 16; levofloxacin, 16; rifampicin, 0.004; daptomycin, 0.19; linezolid, 0.38; and vancomycin, 0.5. Transthoracic echocardiography revealed normal functioning valves, without evidence of vegetation, thrombi or pericardial effusion. Transoesophageal echocardiography on hospital day 2 detected a small mobile echodensity attached to the mitral valve, consistent with a vegetation. Urine and sputum cultures remained negative for bacterial growth.

High-Dose Daptomycin Therapy for Left-Sided Infective Endocarditis: a Prospective Study from the International Collaboration on Endocarditis

“…In 2006, the U.S. Food and Drug Administration (FDA) approved daptomycin for the treatment of bacteremia and right-sided IE caused by Staphylococcus aureus (7,8). Since that time, the successful use of daptomycin in the treatment of IE due to other Gram-positive organisms, including coagulase-negative staphylococci (CoNS), streptococci, Enterococcus faecalis, and Corynebacterium, has been reported (9)(10)(11)(12)(13). Recent literature suggests that daptomycin may be useful in the treatment of left-sided IE as well as right-sided IE (14)(15)(16).…”

Updated Antimicrobial Therapy for the Prevention and Treatment of Endocarditis: Focus on Daptomycin

“…A number of the case studies included in the current review illustrate the difficulty successfully treating IE, particularly in patients with multiple comorbidities, 33 where salvage therapy is impossible or where intolerance to conventional antibiotics is a problem. 31,32 The published case reports also provide support for the use of daptomycin where patients have been treated unsuccessfully (sometimes for prolonged periods and with resistant organisms 45 ) with vancomycin ± rifampin.…”

“…32 The patient with E. faecalis IE became apyrexial on day 4 and remained on therapy for 6 weeks. 31 Dalal et al reported the complete recovery of a patient with end stage renal disease and Corynebacterium amycolatum IE treated with 8 mg/kg every 48 h. 33 An extensive review of the use of daptomycin bacteraemia and endocarditis published in 2008, concluded that daptomycin might prove to be a useful addition to the clinical armamentarium in the presence of bacteraemia associated with prosthesis, but highlighted the need for additional data on higher doses and combination use.…”

Um caso excepcional de miopericardite por Corynebacterium amycolatum

“…Todavia, a sua prevalência está a aumentar nos doentes hospitalizados, nomeadamente em relação a infecção da pele cirúrgica, seguida dos Staphylococcus aureus 1 . São ainda descritas como causa de endocardite aguda (7,5-29%), especialmente quando associada a doença cardíaca estrutural subjacente, a próte-ses valvulares ou catéteres intravasculares 2,3 . Contudo, até ao momento, não existe nenhum caso descrito na literatura Um caso excepcional de miopericardite por corynebacterium amycolatum CASO CLÍNICO realizada na ausência de disfunção ventricular sistólica ou de sintomas de insuficiência cardíaca 4,5 .…”

“…Todavia, a sua prevalência está a aumentar nos doentes hospitalizados, nomeadamente em relação a infecção da pele cirúrgica, seguida dos Staphylococcus aureus 1 . São ainda descritas como causa de endocardite aguda (7,5-29%), especialmente quando associada a doença cardíaca estrutural subjacente, a próte-ses valvulares ou catéteres intravasculares 2,3 . …”