Corynebacterium striatum: A True Pathogen in Chronic Contiguous Osteomyelitis

Table 1

Patients’ characteristics.

Patients	Age/sex	Comorbities	OM location	Diagnosed by	Surgical intervention	Microbiology				Outcome^a
						Preoperative cultures	Prior antibiotics	Intraoperative cultures	Antibiotics postintervention
1	61/M	Unresectable HCC (on sorafenib), cirrhosis due to HCV	Left sternoclavicular joint	Positive PTB	Debridement, clavicle removal	MSSA, P. aeruginosa, diphtheroids	(Nafcillin, cefazolin, cephalexin), meropenem	C. striatum	Vancomycin	Cure
2	53/M	IDDM, neuropathy, ESRD via A-V fistula, s/p left TMA	Left TMA amputation	Positive PTB, MRI	Debridement	E. coli, Enterococcus faecium, diphtheroids	Ceftriaxone- > cefepime, metronidazole	Enterobacter cloacae, K. oxytoca, Enterococcus faecium (VRE), Staph. lugdunensis, C. striatum	Vancomycin, cefepime, metronidazole	Cure
3	70/F	IDDM, polyneuropathy, CAD, CHF, and tobacco abuse	Left calcaneus	Positive PTB, MRI	Partial calcanectomy with graft	P. aeruginosa, diphtheroids	Ciprofloxacin, metronidazole	C. striatum, VRE	Linezolid, ciprofloxacin, metronidazole	Cure
4	71/M	DM, s/p R BKA, chronic venous stasis	Left heel	Positive PTB	Debridement	Polymicrobial, not identified further	Amoxicillin-clavulanate, levofloxacin	C. striatum ESBL E.coli VRE	Vancomycin, ertapenem	Cure
5	87/M	DM, CHF, prostate cancer in remission	Left calcaneus	Positive PTB	Debridement	E. faecalis, MRSA, Morganella spp, C. striatum	Vancomycin, piperacillin-tazobactum	C. striatum	Vancomycin	Cure
6	48/F	Diabetic neuropathy, PAD, and tobacco abuse	Left great toe	Positive PTB	Amputation	P. aeruginosa, E. faecalis, C. striatum	Cephalexin- > vancomycin, meropenem	C. striatum	Vancomycin, meropenem- > linezolid, ciprofloxacin	Cure
7	61/M	DM neuropathy	Right calcaneus	Positive PTB, MRI	Excisional debridement, calcanectomy	K. oxytoca, Proteus mirabilis, Myroides spp, diphtheroids	Amoxicillin-clavulanate, ciprofloxacin	C. striatum	Vancomycin ceftriaxone metronidazole	Cure

^aCure is defined as granulation of the infected wound and resolution of clinical symptoms at 6- to 8-week follow-up. A-V fistula: arteriovenous fistula; CAD: coronary artery disease; CHF: congestive heart failure; C. striatum: Corynebacterium striatum; DM: diabetes mellitus; E. faecalis: Enterococcus faecalis; E.coli: Escherichia coli; ESBL: extended-spectrum beta-lactamase; ESRD: end-stage renal disease; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; K. oxytoca: Klebsiella oxytoca; MSSA: methicillin-susceptible Staphylococcus aureus; MRI: magnetic resonance imaging; MRSA: methicillin-resistant Staphylococcus aureus; OM: osteomyelitis; PTB: probe to bone; Staph: Staphylococcus; VRE: vancomycin-resistant Enterococcus; P. aeruginosa: Pseudomonas aeruginosa; TMA: transmetatarsal amputation.