The Fate of Periprosthetic Joint Infection With Corynebacterium striatum: A Rare but Catastrophic Causative Organism.

Abstract

The virulence and antibiotic resistance profile of an infecting organism have been shown to impact the outcomes of periprosthetic joint infection (PJI). However, there are no existing data on the outcomes of PJI caused by Corynebacterium striatum, a rare organism. Thus, our objective is to ascertain: (1) the treatment success of PJI caused by this rare organism and (2) patient characteristics in the setting of C striatum PJI. A retrospective review was conducted on 741 consecutive PJIs managed at 2 hospital facilities by 8 surgeons (February 4, 2015 to October 30, 2019). The inclusion criteria represented the presence of minimum 1 positive culture of C.striatum. After excluding 1 patient with no follow-up, 15 patients were finally analyzed (9 hips/6 knees). Out of 15 patients, 9 underwent explantation with spacer insertion, 5 underwent irrigation and debridement with polyexchange (I&D), and 1 underwent Girdlestone. Out of 9 explanted patients, only 6 cleared infection and were reimplanted. The clinical staging system for PJI was determined using McPherson classification. The mean follow-ups for I&D and explantation were 35 and 23.5 months, respectively. Success of reimplantation was determined using Delphi criteria. Out of 5 I&D patients, 40% had to be reoperated because of persistent infection. Out of 6 explanted patients who were reimplanted, 67% failed. According to McPherson, 40% of I&D and 22.2% of explanted patients were significantly compromised hosts. C.striatum PJI has a high-treatment failure rate in patient undergoing I&D or 2-stage revision surgery. Surgeons should be aware of the difficulty controlling this PJI and advise patients accordingly.