Abstract
Corynebacterium is a genus that can contaminate blood cultures and also cause severe infections like infective endocarditis (IE). Our purpose was to investigate microbiological and clinical features associated with contamination and true infection. A retrospective population-based study of Corynebacterium bacteremia 2012–2017 in southern Sweden was performed. Corynebacterium isolates were species determined using a matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Patient were, from the medical records, classified as having true infection or contamination caused by Corynebacterium through a scheme considering both bacteriological and clinical features and the groups were compared. Three hundred thirty-nine episodes of bacteremia with Corynebacterium were identified in 335 patients of which 30 (8.8%) episodes were classified as true infection. Thirteen patients with true bacteremia had only one positive blood culture. Infections were typically community acquired and affected mostly older males with comorbidities. The focus of infection was most often unknown, and in-hospital mortality was around 10% in both the groups with true infection and contamination. Corynebacterium jeikeium and Corynebacterium striatum were significantly overrepresented in the group with true infection, whereas Corynebacterium afermentans was significantly more common in the contamination group. Eight episodes of IE were identified, all of which in patients with heart valve prosthesis. Six of the IE cases affected the aortic valve and six of seven patients were male. The species of Corynebacterium in blood cultures can help to determine if a finding represent true infection or contamination. The finding of a single blood culture with Corynebacterium does not exclude true infection such as IE.
Highlights
Corynebacterium is a genus of Gram-positive rods comprising more than 100 species of which a large proportion hasWhen Corynebacterium is isolated from blood cultures, the finding is often dismissed as a contamination from normal skin flora rather than recognized as a pathogen causing true infection
Thirty (8.8%) episodes were classified as true infection, whereas 309 (91%) episodes were classified as contamination
This work demonstrates that Corynebacterium is a rare cause of severe infections and that bacteremia often represent contamination
Summary
Corynebacterium is a genus of Gram-positive rods comprising more than 100 species of which a large proportion hasWhen Corynebacterium is isolated from blood cultures, the finding is often dismissed as a contamination from normal skin flora rather than recognized as a pathogen causing true infection. Some studies have only used a bacteriological criterion (≥ 2 positive blood cultures) [2, 3] whereas other studies considered clinical features and acknowledge that intravascular devices are risk factors for true Corynebacterium infection [4,5,6]. From a large systematic review it was concluded that Corynebacterium IE mainly affects the left side of the heart (95% of cases) and that men constituted 72% of described cases [9]. In this case review, 19% of cases represented valve prosthesis IE and the mortality rate was high (40%) [9]. A difference in clinical presentation between different species of corynebacterial was noted [9]
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