Abstract 17682: Recurrent Corynebacterium Striatum Infective Endocarditis: A Case Series and Patient-Specific Risk Factors

Abstract

Introduction: Corynebacterium species traditionally classified as culture contaminant is now emerging as a cause of recurrent bacteremia and infective endocarditis (IE) especially in patients with cardiac devices. The ability to form biofilms and propensity for antibiotic resistance causes recurrent infections making treatment very challenging. Current literature about Corynebacterium IE, the risk factors and predictors of recurrence is very limited. Methods: We report 2 cases with recurrent Corynebacterium bacteremia and endocarditis and describe their individual risk factors and management. Results: The first patient, a 52-year-old female with chronic tracheostomy due to bilateral vocal fold paresis and prior pseudomonas aortic valve endocarditis s/p aortic valve replacement with 2 episodes of recurrent Corynebacterium bacteremia. Her risk factors for recurrence being prosthetic valve and chronic tracheostomy. Was initially bacteremic with Corynebacterium striatum and positive TEE showing 1cm aortic valve vegetation treated with vancomycin for 6 weeks. She represented 3 months later with recurrent Corynebacterium bacteremia. In addition to antibiotics required tracheostomy decannulation and right cordotomy as definitive therapy. The second patient, a 76 year old male with history of ESRD on HD, heart failure with BiV ICD with 3 prior episodes of recurrent Corynebacterium bacteremia. His risk factors being chronic hemodialysis and presence of ICD. Initial 3 episodes were thought to be secondary to infected permcath which was replaced and then substituted by AV fistula. TEE at all times was negative. Device removal was recommended but patient refused and was treated with 6 weeks of vancomycin each time. Was readmitted for the fourth time with recurrent Corynebacterium striatum bacteremia. TEE remained negative. ICD was deemed as the nidus of recurrent infection and eventually underwent ICD lead extraction. Conclusion: We illustrate the variability in patient characteristics and risk factors for recurrent Corynebacterium endocarditis. Presence of tracheostomy, chronic HD and cardiac devices are possible risk factors. Surgical intervention seems to be the only curative option in these cases.