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Corynebacterium species Updated October, 2010
MICROBIOLOGY Guided Medline Search The genus Corynebacterium encompasses a heterogeneous collection of Gram-positive rod-shaped bacteria (5). They are related to mycobacteria and nocardia, with which they share many biochemical characteristics. Historically, species were often classified as corynebacteria solely on the basis of morphologic characteristics, and the group as a whole was referred to as “diphtheroids” or “coryneform bacilli”. Renewed interest in taxonomy, augmented by genetic sequencing, has led to re-evaluation of the classification of many species, with the result that several have been removed from this genus (e.g. Arcanobacterium haemolyticum and Rhodococcus equi). We have attempted to use the currently accepted terminology but future revisions are inevitable. Table 1 lists some of the species that have been renamed and their older designations. Baron EJ. Flow Chart from Colony on BAP Baron EJ. Flow Chart Aerobic Gram Positive Organisms
EPIDEMILOGY Guided Medline Search Many corynebacteria are part of the normal flora of the skin and mucous membranes of humans and other mammals. In addition to isolation from human specimens, C. urealyticum and C. jeikeium have been isolated from the inanimate hospital environment. The natural habitat of some corynebacteria not thought to cause human infection is the environment.
CLINICAL MANIFESTATIONS Guided Medline Search With the exception of C. diphtheriae, the corynebacteria were long regarded as non-pathogenic commensals and environmental contaminants. It is now recognized that many species of corynebacteria play a pathogenic role in human and other animal diseases. While they remain a relatively uncommon cause of infection among healthy individuals, they have emerged as important pathogens in immunocompromised hosts and in association with implantable medical devices. The ubiquitous presence of corynebacteria on normal skin complicates the interpreting their clinical significance, even when isolated from normally sterile body fluids or from surgical specimens. This is especially true if only a single culture is positive. Table 2 provides some guidelines to help in assessing the clinical significance of a Corynebacterium isolate but in the end each case must be individually analyzed. With the exception of C. diphtheriae, none of the corynebacteria produce a unique illness that permits clinical diagnosis of a corynebacterial infection prior to receiving results of Gram stains and cultures. Similarly, epidemic clusters of non-diphtheria corynebacterial disease are uncommon, but have been reported for nosocomial C. jeikeium (32) and C. striatum infections (4). Corynebacteria have been identified as causative agents in a wide range of infections, including endocarditis of native and prosthetic valves, bacteremia and sepsis (particularly in immunocompromised hosts), infections associated with implanted medical devices, pharyngitis, pneumonia, otitis media, septic arthritis, osteomyelitis, neonatal sepsis and meningitis, peritonitis associate with continuous ambulatory peritoneal dialysis, wound infections, soft-tissue infections, lymphadenitis, and urinary tract infections.
LABORATORY DAIGNOSIS Guided Medline Search Corynebacteria are rod-shaped, nonsporulating, often pleomorphic bacteria that can Gram stain unevenly. They are slightly curved with non-parallel sides and slightly wider ends giving the “club-shaped” appearance (“coryne” meaning “club” in ancient Greek). The cell wall of all most all species contains short chain mycolic acids (exception C. amycolatum, C. atypicum, and C. kroppenstedtii). The medically relevant species are non-motile and all are catalase positive. Corynebacteria are aerobes (or facultative anaerobes); none are obligate anaerobes. In general, no special specimen collection or handling procedures are required. Most species will grow readily in a growth media containing serum, such as sheep blood agar. However, if lipophilic corynebacteria such as C. jeikeium or C. urealyticum are being sought, Tween 80 (Merck, Karmstadt, Germany) should be added to the media. Specialized media such as tellurite agar or Loeffler’s medium that are used to detect C. diphtheriae will also support the growth of other Corynebacterium species. Cultures should be incubated at 37°Celcius in a CO2-enriched environment. Staining of organisms from a colony or broth media are often arranged as single cells, in pairs, in V forms, in palisades, or in clusters that resemble “Chinese characters”. Assigning an isolate to a specific species can be difficult and time consuming. Traditional typing methods based on biochemical characteristics are still used and commercial kits are available. However, not all species are in the kit databases and further testing may be required for accurate speciation. Chromatographic analysis of cell wall fatty acids (37) and molecular-based identification systems are replacing the traditional methods, particularly in reference laboratories.
PATHOGENESIS Guided Medline Search Little is known about the pathogenesis of corynebacteria. Some species have the ability to aggregate and form biofilm, facilitating nosocomial infections of indwelling medical devices.
SUSCEPTIBLITY IN VITRO AND IN VIVO Guided Medline Search In Vitro and In Vivo The Clinical and Laboratory Standards Institute has recently published standardized methodology and interpretive criteria for susceptibility testing of corynebacteria using a broth microdilution method (1). Other methods used include E test (AB Biodisk, Solna, Sweden) and agar dilution. The MIC results obtained with E tests have been shown to correlate well with those of broth microdilution and agar dilution (21, 40). Antimicrobial susceptibility is highly variable within and between species. Antibiotic selection should be based on the results of susceptibility testing of each individual patient’s isolate, where possible. When empirical antibiotic therapy is necessary, some generalizations can help when the microbiology reports the isolation of a “diphtheroid” with susceptibilities to follow. Virtually all corynebacteria are susceptible to the glycopeptides antibiotics, vancomycin and teicoplanin. Minimal inhibitory concentrations (MIC) to these two agents are usually similar, but here is much more clinical experience with vancomycin. Doxycycline is also highly active against most strains, except for isolates of C. jeikeium, C. urealyticum, and C. striatum. Unfortunately, recent studies have demonstrated increasing levels of resistance to there agents in a wide range of corynebacteria, as well as variable susceptibly to clindamycin, quinolones, and the new macrolides (azithromycin and clarithromycin) (14, 34). Addition of the β-lactamase inhibitor clavulanic acid does not affect the MICs to β-lactam antibiotics (9) (Table 3).
ANTIMICROBIAL THERAPY Smart search Drugs of Choice Guided Medline Search Recommendations for antimicrobial therapy for corynebacterial infections are largely empirical. Because these infections are sporadic and infrequent, conventional controlled therapeutic trails have never been conducted. Thus, recommendations must be based on compilations of reported cases and the results of in vitro susceptibility testing (3, 11-14, 30, 31, 39). On the basis of in vitro observations, vancomycin should be included in the empirical treatment regimen of all life-threatening infections caused by corynebacteria. To minimize the unnecessary use of glycopeptides antibiotics, the need for continued vancomycin therapy must be reassessed once susceptibility testing results become available. Vancomycin is also indicated in empirical therapy of serious but non life-threatening infections of the urinary tract, especially if nephrolithiasis is present (because of the likelihood of C. urealyticum) and in hospitalized neutropenic patients (in whom C. jeikeium is possible). For other serious infections requiring parenteral therapy, empirical regimens should include a β-lactam antibiotic (e.g. a penicillin or cephalosporin). The semi-synthetic penicillins such as oxacillin are less active in vitro and should be avoided. First generation cephalosporins are generally at least as active as second- or third generation agents. For less serious infections, especially those involving skin, soft tissue, or the upper respiratory tract, oral therapy with doxycycline is the most logical choice. An oral macrolide or β-lactam are acceptable alternatives. The newer antibiotics may provide further options for treating infections due to corynebacteria. Telavancin, daptomycin, and linezolid typically, although not exclusively, have low MICs (≤0.05 µg/ml) for all corynebacteria. However, clinical correlation of these in vitro data is lacking. When tested against some of the more resistant species including C. jeikeium, C. amycolatum, and C. urealyticum, quinopristin-dalfopristin and telithromycin have in vitro activity against most, but not all, isolates. Dosage and duration of therapy are determined by the site and seriousness of the infection. Ghide S, et al. Catheter-Related Corynebacterium bacteremia: Should the Catheter be Removed and Vancomycin Administered? Eur J Clin Microbiol Infect Dis. 2010 Feb;29:153-6. Guidelines For Infections Due to Specific Corynebacterium Species Corynebacterium amycolatum: C. amycolatum is probably the most commonly encountered corynebacteria in human clinical specimens (19). Because of variability in their biochemical reactions, in the past many strains of C. amycolatum were misidentified as C. xerosis, C. striatum or C. minutissimum (8). C. amycolatum causes a range of infections including endocarditis, intravenous catheter-related bacteremia, pneumonia, peritonitis, and skin and soft tissue infections. Often these infections are nosocomially acquired. C. amycolatum strains demonstrate variable susceptibility patterns in vitro. They are often resistant to penicillin and ampicillin, gentamicin, macrolides and quinolones, but are usually susceptible to linezolid, tetracycline, and imipenem. All strains tested have been susceptible to vancomycin. Most case reports of invasive infection due to C. amycolatum have been successfully treated with vancomycin, sometimes in combination with another agent. Corynebacterium aquaticum: The relatively uncommon human pathogen C. aquaticum has been implicated in several serious infections, including endocarditis, bacteremia, peritonitis (in association with peritoneal dialysis), and neonatal infections. Water-borne transmission was suspected in some cases. While many strains are broadly susceptible, resistance to β-lactams is reported, sometimes in up to 50% of isolates. Nonetheless, most reported patients have responded to therapy with penicillin or ampicillin, often in combination with an aminoglycoside. Ampicillin (or penicillin) appears to be the treatment of choice if the organism is known to be susceptible. Given the prevalence of penicillin resistance, vancomycin should be used initially in life-threatening infections, pending the results of susceptibility testing. Corynebacterium jeikeium: Like C. amycolatum, C. jeikeium is one of the more frequently isolated corynebacteria and is an important pathogen of immunocompromised hosts. Risk factors for invasive disease include prolonged hospitalization, neutropenia, prior treatment with antibiotics, and disruption of the integument (wounds, intravenous catheters). Skin colonization, particularly in the axilla and groin, has been documented in 40 to 82% of hospitalized patients with malignancies. Several hospital case clusters have been associated with high carriage rates on the hands of health care workers as well as environmental contamination of room surfaces and air. The results of epidemiologic studies have both favored and disputed nosocomial transmission (17, 18). Initial reports of C. jeikeium infections stressed septicaemia and wound infections as the most common clinical manifestations. More recently, C. jeikeium has been accepted as a cause of endocarditis (including native valves), bacteremia, pneumonia, skin/soft tissue and bone/joint infections, intravenous catheter-related infections, and ventriculoperitoneal shunt infections (6, 15, 23).
A distinguishing characteristic of C. jeikeium is its constitutive
resistance to most antibiotics. All isolates have been susceptible to
vancomycin, but only 4 – 15% are susceptible to erythromycin, and 4 – 18% to
penicillin (30, 38, 39).
Some isolates are susceptible to rifampicin, doxycycline and ciprofloxacin
although quinolone resistance seems to be increasing. Virtually all successfully
treated patients reported in the literature have received vancomycin, which must
be regarded as the drug of choice for C. jeikeium infections. Alternative
therapy would have to be determined by susceptibility testing. Cure of most
C. jeikeium infections associated with prosthetic valves or invasive lines
has required removal of the foreign material. Successful therapy of CSF shunt
infections has been achieved with combined intravenous and intrathecal
vancomycin for 10 days followed by removal of the original shunt hardware and
continuation of intrathecal (with or without intravenous) vancomycin for an
additional 6 to 14 days (15). The authors of this study did
not report the dose of intrathecal vancomycin, but a dose of 3 to 5 mg (in
adults) should produce adequate CSF drugs levels. The optimal timing for
installation of a new shunt is uncertain, but if can often be successfully
accomplished at the same time the original shunt is removed. Corynebacterium minutissimum: C. minutissimum is best known as the putative etiologic agent of erythrasma, a common and relatively mild skin condition characterized by brownish macules in intertriginous areas. Risk factors for erythrasma include male gender and diabetes mellitus. The clinical diagnosis is made by demonstrating coral-red fluorescence of characteristic lesions when illuminated with ultraviolet (Wood’s) light. The etiologic role of C. minutissimum has not been unequivocally established, and another species of corynebacteria may be the true etiologic agent. Alternatively, erythrasma may be a common result of infection by any of several diphtheroid species. More serious infections with C. minutissimum have been reported, including skin and soft-tissue infection/abscess, bacteremia, endocarditis, and meningitis. Erythrasma has traditionally been treated with oral erythromycin (250mg four times a day for 14 days). Topical clindamycin (2% aqueous solution) is an alternative. Susceptibility testing results have been reported for relatively few isolates, but erythromycin resistance is relatively common (>70% in one series) (39). It has been postulated that certain biotypes (propionic acid producing) of C. minutissimum are broadly resistant (36). Among the few reported patients with invasive disease, some were successfully treated with vancomycin or penicillin, while others failed therapy with β-lactam agents. Based on these reports and in vitro data, vancomycin should be the drug of choice for invasive disease, with penicillin or ampicillin as alternative choices if the isolate is demonstrated to be susceptible. Corynebacterium pseudodiphtheriticum: C. pseudodiphtheriticum can be found in the pharyngeal flora of healthy adults. It does not produce toxins but its growth characteristics, colonial morphology, and appearance in Gram-stained smears resemble those of C. diphtheriae, occasionally resulting in an incorrect presumptive diagnosis of diphtheria (16). Interestingly, there have been occasional cases of exudative upper respiratory tract infection reported in the literature with C. pseudodiphtheriticum isolated from clinical specimens. C. pseudodiphtheriticum is most often encountered as a pathogen in infections of the lower respiratory tract in both immunocompetent and compromised hosts (2, 20, 24). In one patient with AIDS, C. pseudodiphtheriticum was associated with a lung abscess, mimicking the clinical syndrome observed with Rhodococcus equi in these patients. It has also been reported causing endocarditis (of both prosthetic and native valves), suppurative lymphadenitis, keratitis and cutaneous infections. Most strains of C. pseudodiphtheriticum are broadly susceptible to β-lactam antibiotics. Penicillin or ampicillin should be regarded as the agent of choice for pulmonary infections caused by C. pseudodiphtheriticum. Addition of an aminoglycoside is often recommended for treating C. pseudodiphtheriticum endocarditis but has not been proven necessary for cure (24). Alternative agents for respiratory tract infections include clindamycin, a macrolide (erythromycin or azithromycin), or a fluoroquinolones, although occasional strains are resistant in vitro to some or all of these agents. Clinical treatment failures are very rare and usually occur in the setting of rapidly fatal comorbid conditions. Endocarditis in patients with documented hypersensitivity to penicillin is probable best managed by desensitization, although vancomycin may be an effective alternative therapy. Corynebacterium pseudotuberculosis: C. pseudotuberculosis is a well recognized pathogen of domestic and wild animals. Infection can produce pneumonia or suppurative lymphadenitis in several species, most commonly sheep and goats, but also horses, cattle and deer. Contact with sheep (or their hides or offal) has been reported in over 80% of cases of human infection with C. pseudotuberculosis, and other cases have been linked to the ingestion of raw milk. Almost all strains of C. pseudotuberculosis produce a dermonecrotic toxin. This exotoxin is a phospholipase D, similar in activity (although immunologically distinct) to the phospholipase D present in the venom of Loxoscele recluse, the brown recluse spider. Some strains are also capable of producing diphtheria toxin. The most common manifestation of C. pseudotuberculosis infection in humans is suppurative granulomatous lymphadenitis. Some cases of pneumonia have been reported. One patient with cervical adenitis has mild exudative tonsillitis, but diphtheria-like pharyngitis has not been reported. Most tested isolates have shown susceptibility to a broad range of antibiotics, including penicillin, cephalosporins, tetracycline, erythromycin, and chloramphenicol. Successful therapy of suppurative lymphadenitis has required surgery (lymph node excision and drainage of purulent material) and antibiotics, usually erythromycin or tetracycline. A notable feature of human infection with C. pseudotuberculosis is its tendency of local recurrence after apparent clinical resolution. Many of the published case reports stress the need for prolonged antibiotic therapy (often 6 – 12 weeks), repeated surgical exploration with excision and drainage of purulence or necrotic tissue, and long-term clinical follow-up to identify late relapse (28). Corynebacterium striatum: C. striatum is part of the normal flora of the anterior nares and skin (especially above the waist). It has been reported predominately as a causative agent in lower respiratory tract infections. In addition, C. striatum can cause bacteremia, endocarditis, intravenous catheter-related infections, skin and soft tissue infection, chorioamnionitis, conjunctivitis, meningitis (post-traumatic), and peritonitis associated with peritoneal dialysis. In the past, most cases are believed to arise from invasive by endogenous strains, but molecular strain typing of hospital isolates of C. striatum have established its role as a nosocomial pathogen (4, 26). In a surgical intensive care unit with C. striatum isolated from 14 patients, transmission between patients apparently occurred through transient carriage on the hands of health care workers (4). C. striatum is susceptible to vancomycin, rifampicin, and aminoglycosides, and some strains are susceptible to penicillin, erythromycin, ciprofloxacin, and imipenem. Multidrug-resistant strains have been isolated from long-term hospitalized patients with comorbid conditions (26, 29). Penicillin remains the drug of choice for susceptible strains, while vancomycin is a reasonable choice for empirical therapy of serious infections such as meningitis and endocarditis, pending the results of susceptibility testing. Corynebacterium ulcerans: Like C. pseudotuberculosis, C. ulcerans is a zoonotic pathogen. It can produce bovine mastitis, with concomitant contamination of the milk but is often simply a component of the normal intestinal flora in horse and cattle. Human cases occur most commonly during the summer and are often, but not always, associated with exposure to livestock. A recent study comparing strains from domestic cats and humans using ribotyping found that cat strains share the predominant ribotypes observed among human isolates, suggesting that domestic cats may be a potential reservoir for human infection due to C. ulcerans (7). Many strains of C. ulcerans produce diphtheria toxin, and some produce a dermonecrotic toxin similar or identical to that of C. pseudotuberculosis. In contrast to the disease syndromes characteristics of C. pseudotuberculosis, C. ulcerans is predominately a pathogen of the oropharnyx and lower respiratory tract in humans. The pharyngitis is generally mild, but disease due to toxigenic strains can mimic diphtheria, including its neurologic and cardiac abnormalities. In this clinical setting, contact investigation and post-exposure prophylaxis of close face-to-face contacts is advised (35). Lower respiratory tract involvement can manifest as a nonspecific pneumonia or as pulmonary nodules comprised of necrotizing granulomatous inflammation. Skin and soft-tissue infection has also been reported. In vitro susceptibility testing of C. ulcerans strains demonstrates their susceptibility to a broad range of antimicrobial agents. Published cases were usually treated successfully with either erythromycin or penicillin. A recent case report of diphtheria-like illness due to C. ulcerans in a 66-year old woman highlights the potential therapeutic benefit of treatment with diphtheria antitoxin in patients with severe toxigenic C. ulcerans pharyngitis (35). Corynebacterium urealyticum: As implied by its name, urease activity is the distinguishing characteristic of C. urealyticum. Its environmental reservoir is poorly defined, but it can colonize human skin, where it is found in up to one-third of hospitalized patients. When it produces human disease, C. urealyticum is almost exclusively associated with infections of the upper and lower urinary tract and complications arising from these infections. Among reported cases, the overwhelming majority of patients were hospitalized (or had recently been hospitalized), were immunocompromised, had recently undergone instrumentation of the urologic tract, and had received antibiotics (10, 25, 33). Half had a history of a urologic disorder. Non-urinary infections have been reported rarely (in less than 5% of cases), including bacteremia, endocarditis, peritonitis, respiratory tract infection, bone and joint, and skin and soft tissue infection. Alkaline-encrusted cystitis and pyelitis are unusual clinical syndromes frequently associated with C. urealyticum infection (22). These chronic inflammatory diseases of the bladder and renal pelvis (respectively) are marked by deposition of struvite (ammonium magnesium phosphate), with ulceration, localized necrosis and marked inflammation. These changes, which are often irreversible and can lead to progressive renal impairment, have also been associated with infection by other urea-splitting bacteria such as Proteus species. Patients with alkaline-encrusted cystitis complain of gross hematuria, cloudy urine, and passage of gritty material or small stones in the urine, in addition to the usual cystitis symptoms of dysuria and suprapubic pain. Low-grade fever may be present. Pyuria is common, and the urine invariably has an alkaline pH and contains struvite crystals. The clinical presentation and urinalysis findings are generally sufficient to make the diagnosis of alkaline-encrusted cystitis/pyelitis, but cystocopy can be useful in confirming the diagnosis and for therapy (see below). Computerized tomography is useful for the early diagnosis and follow-up of alkaline-encrusted pyelitis. Antimicrobial susceptibility testing has shown C. urealyticum to be among the more resistant species of corynebacteria. All stains tested have been susceptible to vancomycin, and linezolid appears to have activity in vitro. Fluoroquinolones, such as ciprofloxacin, are active against most isolates, but susceptibility to rifampicin, tetracycline, erythromycin, nitrofurantoin, and gentamicin is variable. Vancomycin and the fluoroquinolones retain their antimicrobial activity at alkaline pH, unlike many other antibiotics. Based on reported clinical efficacy, vancomycin is the antibiotics of choice, but when oral therapy is an option, tetracycline or a fluoroquinolone are acceptable alternatives. Prolonged antibiotic therapy as well as urinary acidification and cystocsopic or surgical resection of struvite deposits is necessary for cure of alkaline-encrusted cystitis. Kim DHD, et al. Medical mystery: concentric calcification. N Engl J Med. 2006;354:508. Yu VL, et al. Medical mystery: concentric calcification - the answer. N Engl J Med. 2006;354:1433. Corynebacterium xerosis: C. xerosis is found on the skin and mucosal surfaces of the nasopharynx, and has been associated with only a few cases of human disease. Endocarditis, mediastinitis, pneumonia, brain abscess, and infection of CSF shunts have been reported. However, in the past some C. amycolatum isolates may have been misidentified as C. xerosis (8). Vancomycin and tetracycline are the most consistently active agents in vitro: susceptibility to penicillin and erythromycin is variable. Almost all reported cases have been treated successfully with parenteral penicillin (or ampicillin) or vancomycin. Doxycycline might be an acceptable alternative when oral therapy is appropriate. Corynebacterium Species Associated with Rare Cases of Human Disease Several other Corynebacterium species including C. accolens, C. afermentans subsp. lipophilum, C. glucuronolyticum, C. macginleyi, C. pilosum, C. resistans and members of coryneform groups A4, ANF-3, and G-2, have been linked to rare cases of human infection. Most of the isolates tested have shown in vitro susceptibility to a broad range of antimicrobial agents. Special Infections Endocarditis: Corynebacteria (including non-toxigenic strains of C. diphtheria) are an uncommon but increasingly recognized cause of bacterial endocarditis, effecting both native and prosthetic valves. Recognized risk factors for endocarditis due to corynebacteria include a past history of endocarditis, pre-existing valvular disease, and presence of prosthetic material. A recent review of published cases of endocarditis due to corynebacteria found that the majority of cases were seen in male adults, and noted a predilection for left sided endocarditis. The most commonly encountered species were non-toxigenic C. diphtheria (47%), C. pseudodiphtheriticum (11%), C. striatum (11%), toxigenic C. diphtheria (10%), and C. xerosis (3%) (23). Attributable mortality was high (43%) with lowest survival among patients infected with toxigenic C. diphtheria (14%) and C. pseudodiphtheriticum (33%). Management of endocarditis depends on the infecting organism’s antibiotic susceptibility. Vancomycin should be used empirically or in those allergic to penicillin. For a susceptible strain, penicillin with or without the addition of an aminoglycoside is recommended. Belmares J, Detterline S, et al. Corynebacterium endocarditis species-specific risk factors and outcomes. BMC Infect Dis 2007;7:4. Granulomatous Lobular Mastitis: Corynebacteria are not infrequently isolated from skin and soft tissue, and increasingly are considered to have a pathogenic role in some skin and soft tissue infection. A recent example of this is an association between corynebacteria (particularly C. kroppenstedtii) and granulomatous lobular mastitis of the breast (27). The authors conclude that the presence of Gram-positive bacilli surrounded by inflammatory cells in breast tissue, and repeated isolation of corynebacteria, support a pathogenic role. Similar findings have been reported by other groups. Suggested treatment includes antibiotic therapy with doxycycline although there are no randomised trials to support this recommendation. Combination Therapy Combination of antibiotics has not been shown to be any more effective than single agents and cannot be recommended for empirical therapy. (Printable Version of Antimicrobial Therapy for Corynebacterium)
ADJUNCTIVE THERAPY Guided Medline Search Definite cure of corynebacterial infection of prosthetic devices often requires surgical removal of the foreign body, but in most instances this does not have to be done emergently. Adjunctive therapy for alkaline-encrusted cystitis/pyelitis is covered under the C. urealyticum section.
ENDPOINTS FOR MONITORING THERAPY Guided Medline Search There are no specific endpoints for monitoring therapy.
VACCINES Guided Medline Search There are no vaccines in current use for corynebacteria other than C. diphtheria.
PREVENTION OR INFECTION CONTROL Guided Medline Search Smart search There are no specific recommendations for the prevention of infections due to corynebacteria. The increasing recognition that some corynebacteria, including C. jeikeium, C. striatum and C. urealyticum, can be nosocomially acquired should serve as a reminder to all health care providers to maintain excellent standards of infection control practice at all times.
TABLES Table 1. Corynebacteria Nomenclature Table 2. Guidelines for Assessing the Clinical Significance of a Corynebacterium Isolate Table 3: Single Drug (MICs in Table)
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