Corynebacterium Striatum: A Concerning Pathogen of Osteomyelitis in the Diabetic Patient

2016 ◽  
Vol 106 (sp1) ◽  
pp. 9-9 ◽  
Author(s):  
Sneha A. Patel ◽  
Jackeline Iacovella ◽  
Rhonda S. Cornell
Keyword(s):  
Diabetic Foot ◽  
Bone Culture ◽  
Diabetic Foot Infections ◽  
Corynebacterium Striatum ◽  
Potential Pathogen ◽  
Type Ii Diabetics ◽  
And Gender ◽  
Extended Course ◽  
Diabetic Foot Osteomyelitis ◽  
Bone Cultures

INTRODUCTION AND OBJECTIVES: Corynebacterium striatum (C. striatum) is known to colonize the skin and mucous membranes of most normal human hosts. While it is frequently isolated in clinical laboratories, the clinical significance of C. striatum is often unknown with respect to diabetic foot infections with osteomyelitis. There have been very few studies published on this topic, and even fewer that report on treatment courses. To our knowledge, there has been no study published reporting diabetic foot osteomyelitis with isolation of C. striatum from bone culture. METHODS: Four patients were known to have been treated at our facility for C. striatum diabetic foot osteomyelitis. The medical records for each patient were thoroughly reviewed with close attention directed towards the past medical history, wound duration, wound and bone cultures, antimicrobial therapy and clinical outcomes. RESULTS: Bone cultures of all 4 patients were notable for C. striatum. Diphtheroids were also noted on wound cultures for 3 patients which were not speciated. All bone cultures were obtained during surgical treatment of the diabetic foot infection. All patients were type II diabetics but varied with respect to age and gender. All patients were treated with an extended course of antibiotics and/or surgical resection of osteomyelitis. Patients were followed until complete wound closure. CONCLUSIONS: We report four cases of diabetic foot osteomyelitis in which C. striatum was noted and treated as a pathogen. Diphtheroids are often overlooked as a potential pathogen in diabetic foot infections and rarely treated as such. However, our findings suggest that clinicians should consider C. striatum as a possible cause of osteomyelitis, especially when patients fail to completely heal wounds in a timely manner that have previously and repeatedly displayed Diphtheroids from cultures.

scholarly journals Are surrogate markers for diabetic foot osteomyelitis remission reliable?

2020 ◽  
Author(s):  
Peter A Crisologo ◽  
Matthew Malone ◽  
Javier La Fontaine ◽  
Orhan Oz ◽  
Kavita Bhavan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Surrogate Marker ◽  
Surrogate Markers ◽  
Bone Culture ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Index Site ◽  
Diabetic Foot Osteomyelitis

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections. Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05. Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%. Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.

scholarly journals The role of remnant bone microbiological cultures in managing diabetic foot osteomyelitis

2021 ◽  
Author(s):  
Devangi Ketankumar Madani ◽  
Mujahid Ahmad Saeed ◽  
Alok Tiwari ◽  
Miruna Delia David
Keyword(s):  
Diabetic Foot ◽  
Group B Streptococcus ◽  
Bone Culture ◽  
Streptococcus Group ◽  
Streptococcus Anginosus ◽  
Bone Segment ◽  
Forefoot Amputation ◽  
Group B ◽  
The Impact ◽  
Diabetic Foot Osteomyelitis

Aim: Effective treatment of diabetic foot osteomyelitis can reduce the risk of major amputations. Our primary aim was to compare the yield in cultures from the proximal and distal segments of bone excised intraoperatively and the impact on antibiotic choice and duration.Methods: Patients with a confirmed diagnosis of osteomyelitis on bone culture results, where both proximal and distal bone segment samples had been collected, were retrospectively reviewed. Microbiological data were examined to identify true pathogens and studied against antimicrobial choice and duration of prescribing.Results: A total of 47 forefoot amputation cases were studied. In 89% of cases, definite or likely pathogens were isolated from the deep tissues cultured. Definite pathogens (Staphylococcus aureus, Group B streptococcus, Group G streptococcus and Streptococcus anginosus) were identified in 32% of cases; in 73% of these, definite pathogens were grown in both the proximal and distal bone segments.Conclusion: Sampling of remnant bone culture can help in reducing the duration of antibiotic treatment in patients (27% of cases in our series) as it is challenging to correctly estimate intraoperatively whether clear surgical margins have been adequately achieved when resecting infected bone.

scholarly journals Time-to-Report of the Bone Culture and Microbiologic Adequacy of Empiric Antibiotics in Patient’s with Diabetic Foot Osteomyelitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S94-S95
Author(s):  
Hyun Kyung Kim ◽  
Olga Vasylyeva
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Anaerobic Bacteria ◽  
Accurate Method ◽  
Bone Culture ◽  
Culture Result ◽  
Gram Positive ◽  
Diabetic Foot Infection ◽  
Superficial Wound ◽  
Diabetic Foot Osteomyelitis

Abstract Background Bone cultures in diabetic foot infection is the most accurate method to identify causative pathogen, while there is only 30% concordance between superficial wound swab and bone biopsy cultures. Diabetic foot infection is commonly polymicrobial, therefore report on the bone biopsy culture may come with several updates before it is finalized. Our study is aimed to describe how often additional pathogens were identified after patients’ discharge on antibiotics therapy for diabetic foot osteomyelitis, and evaluate microbiological appropriateness of antibiotic regimen upon discharge based on the final result of the bone culture. Methods Medical records of the patients 18 years old or older, who had inpatient bone biopsy, deep tissue debridement or amputation for diabetic foot infection, were reviewed from January 2014 through Dec 2015 in Rochester Regional Health System. Antibiotic regimens for the patients discharged before final culture result were evaluated for microbiological appropriateness by two reviewers trained in infectious diseases. Results In total, 198 procedures were screened, 158 procedures met inclusion criteria, out of which 74 patients with 80 procedures (51%) were discharged before the final culture result was available. Average time from procedure to the final culture report was 6 days, and from discharge to the final culture was 3.7 days. In most of the cases (70%, 56 out of 80) the patients were discharged on empiric regimen discordant with final culture result. Predominant organisms were Gram-positive bacteria 74%, with Gram negatives 24%, and yeast 2%. Most infections were polymicrobial (81%), mixed with anaerobic bacteria in 37%. The most frequent isolates were Staphylococcus aureus (15%), Corynebacterium (14%), anaerobic Gram-positive cocci (12%), and Staphylococcus epidermidis (8%). All negative Gram stains (31%, 25 out of 80) had positive growth on culture. Conclusion Half of the patients with diabetic foot osteomyelitis, who underwent bone biopsy, were discharged before final culture results were available. Most of them were discharged on empiric regimen discordant with final culture. This data suggests that careful outpatient follow-up on the final culture would likely result in modification of antibiotics therapy to target newly reported pathogen. Disclosures All authors: No reported disclosures.

Microbial Profile and Utility of Soft Tissue, Pus, and Bone Cultures in Diagnosing Diabetic Foot Infections

2012 ◽  
Vol 14 (8) ◽  
pp. 669-674 ◽  
Author(s):  
Nadeem Parvez ◽  
Pinaki Dutta ◽  
Pallab Ray ◽  
Viral N. Shah ◽  
Mahesh Prakash ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Microbial Profile ◽  
Diabetic Foot Infections ◽  
Bone Cultures

Fungal Osteomyelitis in Diabetic Foot Infections: A Case Series and Comparative Analysis

2018 ◽  
Vol 17 (3) ◽  
pp. 184-189 ◽  
Author(s):  
Garneisha M. Torrence ◽  
Brian M. Schmidt
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Surgical Intervention ◽  
Laboratory Data ◽  
Case Series ◽  
Bone Culture ◽  
Diabetic Foot Infections ◽  
Fungal Osteomyelitis ◽  
Prospective Longitudinal

Fungal osteomyelitis (OM) is relatively rare. There is scarce literature discussing fungal OM in diabetic foot infections (DFIs). This case series explores the clinical characteristics of patients treated at a large tertiary academic center for DFI and found to have a causative agent of fungal origin in their bone on surgical intervention. Between July 2017 and March 2018, a prospective longitudinal analysis was performed of patients with diabetes admitted to our institution who underwent operative management of OM. Demographic, clinical, radiographic, and laboratory data were collected for all patients. Data between bacterial and fungal OM cohorts was analyzed for differences and similarities in patient characteristics and outcomes. All patients were followed 20 weeks postoperatively. Five patients with fungal OM were identified from the 35 cases where OM was confirmed through podiatric surgical intervention. In each fungal case, a Candida species was isolated from operative bone culture which included subspecies Candida albicans, C parapsilosis, and C glabrata. A P value ⩾.05 was found in clinical characteristics between our cohorts. Wound healing was achieved in 40% of patients with fungal OM, and oral fluconazole successfully treated Candida OM in the cases that achieved healing. Diabetes can increase the risk of Candida OM. In DFIs, fungus can impede wound healing if not recognized and treated. Because Candida OM is typically indolent in nature, bone biopsy and mycological culture is recommended for definitive diagnosis and treatment.

2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infectionsa

2013 ◽  
Vol 103 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Benjamin A. Lipsky ◽  
Anthony R. Berendt ◽  
Paul B. Cornia ◽  
James C. Pile ◽  
Edgar J. G. Peters ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Empiric Antibiotic Therapy ◽  
Diabetic Patients ◽  
Bone Culture ◽  
Healthcare Organizations ◽  
Surgical Interventions ◽  
Diabetic Foot Infections ◽  
Empiric Antibiotic ◽  
Severe Infections

Foot infections are a common and serious problem in persons with diabetes. Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations). This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation. Most DFIs are polymicrobial, with aerobic gram-positive cocci (GPC), and especially staphylococci, the most common causative organisms. Aerobic gram-negative bacilli are frequently copathogens in infections that are chronic or follow antibiotic treatment, and obligate anaerobes may be copathogens in ischemic or necrotic wounds. Wounds without evidence of soft tissue or bone infection do not require antibiotic therapy. For infected wounds, obtain a post-debridement specimen (preferably of tissue) for aerobic and anaerobic culture. Empiric antibiotic therapy can be narrowly targeted at GPC in many acutely infected patients, but those at risk for infection with antibiotic-resistant organisms or with chronic, previously treated, or severe infections usually require broader spectrum regimens. Imaging is helpful in most DFIs; plain radiographs may be sufficient, but magnetic resonance imaging is far more sensitive and specific. Osteomyelitis occurs in many diabetic patients with a foot wound and can be difficult to diagnose (optimally defined by bone culture and histology) and treat (often requiring surgical debridement or resection, and/or prolonged antibiotic therapy). Most DFIs require some surgical intervention, ranging from minor (debridement) to major (resection, amputation). Wounds must also be properly dressed and off-loaded of pressure, and patients need regular follow-up. An ischemic foot may require revascularization, and some nonresponding patients may benefit from selected adjunctive measures. Employing multidisciplinary foot teams improves outcomes. Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFIs.

scholarly journals 320. Does Guideline-Based Management of Diabetic Foot Osteomyelitis Reduce Risk of Further Proximal Amputations?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S232-S232
Author(s):  
Eugene Lee ◽  
Jakrapun Pupaibool ◽  
Laura Certain
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Primary Outcome ◽  
Adherence To Guidelines ◽  
Diabetic Foot Infections ◽  
Significant Difference ◽  
Antibiotic Management ◽  
Reduce Risk ◽  
Reduced Risk ◽  
Diabetic Foot Osteomyelitis

Abstract Background The antibiotic management of diabetic foot osteomyelitis involving surgical limb-sparing amputation is controversial. While there are several guidelines that provide recommendations regarding antibiotic therapy for diabetic foot osteomyelitis after amputation, we do not know of any studies that show that adherence to guidelines improves clinical outcomes. We assessed whether adherence to antibiotic choice and duration in accordance with our institution’s guidelines, which are based on IDSA guidelines, reduced risk of future amputations. Methods We conducted a retrospective cohort study of 110 patients with diabetic foot osteomyelitis treated with limb-sparing amputations at a VA hospital. We collected relevant clinical data such as patient comorbidities, antibiotic allergies, labs, imaging, culture data, histopathologic reports, pre-op and post-op antibiotics. We used our institutional guidelines, which are based on the 2012 IDSA Guidelines for the Diagnosis and Treatment of Diabetic Foot Infections, to assess antibiotic choice and duration for diabetic foot osteomyelitis therapy after amputation. We stratified cases as either adherent or non-adherent based on whether antibiotic choice and duration were both in accordance with our institutional guideline. For each case, we recorded the primary outcome of further proximal amputation occurring within six months or death from all causes within three months. Results We found a significant difference in primary outcomes between the groups that were treated with antibiotics adherent with guidelines and antibiotics non-adherent with guidelines. For patients who were treated with antibiotics that were non-adherent to guidelines, 15 of 36 (42%) patients needed further amputation or died. Of the patients treated according to guidelines, 12 of 74 (16%) patients needed further amputation or died. There was a statistically significant difference between these two groups (p=0.004). Conclusion Our study showed that guideline-based antibiotic therapy for diabetic foot osteomyelitis treated with amputation significantly lowered rates of further amputation compared to antibiotic therapies that were not adherent to guidelines. Disclosures All Authors: No reported disclosures

scholarly journals Culturomics Approach to Identify Diabetic Foot Infection Bacteria

2021 ◽  
Vol 22 (17) ◽  
pp. 9574
Author(s):  
Michał Złoch ◽  
Ewelina Maślak ◽  
Wojciech Kupczyk ◽  
Marek Jackowski ◽  
Paweł Pomastowski ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Culture Media ◽  
Bacterial Species ◽  
Microbial Composition ◽  
Diabetic Foot Infection ◽  
Flight Mass Spectrometry ◽  
Diabetic Foot Infections ◽  
Corynebacterium Striatum ◽  
Vancomycin Resistant ◽  
The Impact

The main goal of the study was to evaluate the usefulness of the culturomics approach in the reflection of diabetic foot infections (DFIs) microbial compositions in Poland. Superficial swab samples of 16 diabetic foot infection patients (Provincial Polyclinical Hospital in Toruń, Poland) were subjected to culturing using 10 different types of media followed by the identification via the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and Biotyper platform. Identified 204 bacterial isolates representing 18 different species—mostly Enterococcus faecalis (63%) and Staphylococcus aureus (44%). Most of the infections (81%) demonstrated a polymicrobial character. Great differences in the species coverage, the number of isolated Gram-positive and Gram-negative bacteria, and the efficiency of the microbial composition reflection between the investigated media were revealed. The use of commonly recommended blood agar allowed to reveal only 53% of the entire microbial composition of the diabetic foot infection samples, which considerably improved when the chromagar orientation and vancomycin-resistant enterococi agar were applied. In general, efficiency increased in the following order: selective < universal < enriched < differential media. Performed analysis also revealed the impact of the culture media composition on the molecular profiles of some bacterial species, such as Corynebacterium striatum, Proteus mirabilis or Morganella morganii that contributed to the differences in the identification quality. Our results indicated that the culturomics approach can significantly improve the accuracy of the reflection of the diabetic foot infections microbial compositions as long as an appropriate media set is selected. The chromagar orientation and vancomycin-resistant enterococi agar media which were used for the first time to study diabetic foot infection microbial profiles demonstrate the highest utility in the culturomics approach and should be included in further studies directed to find a faster and more reliable diabetic foot infection diagnostic tool.

Pathogens Isolated From Deep Soft Tissue and Bone in Patients With Diabetic Foot Infections

2008 ◽  
Vol 98 (4) ◽  
pp. 290-295 ◽  
Author(s):  
M. Bulent Ertugrul ◽  
Selcuk Baktiroglu ◽  
Serpil Salman ◽  
Seher Unal ◽  
Murat Aksoy ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Culture ◽  
Tissue Cultures ◽  
Deep Soft Tissue ◽  
Diabetic Foot Infections ◽  
Grade 3 ◽  
Aseptic Conditions ◽  
Tissue Specimens ◽  
Culture Positive

Background: We sought to determine the similarity of pathogens isolated from soft tissue and bone in patients with diabetic foot infections. It is widely believed that soft-tissue cultures are adequate in the determination of causative bacteria in patients with diabetic foot osteomyelitis. The culture results of specimens taken concurrently from soft-tissue and bone infections show that the former does not predict the latter with sufficient reliability. We sought to determine the similarity of pathogens isolated from soft tissue and bone in patients with diabetic foot infections. Methods: Forty-five patients with diabetic foot infections were enrolled in the study. Patients had to have clinically suspected foot lesions of grade 3 or higher on the Wagner classification system. In patients with clinically suspected osteomyelitis, magnetic resonance imaging, scintigraphy, or histopathologic examination were performed. Bone and deep soft tissue specimens were obtained from all patients by open surgical procedures under aseptic conditions during debridement or amputation. The specimens were compared only with the other specimens taken from the same patients. Results: The results of bone and soft-tissue cultures were identical in 49% (n = 22) of cases. In 11% (n = 5) of cases there were no common pathogens. In 29% (n = 13) of cases there were more pathogens in the soft-tissue specimens; these microorganisms included microbes isolated from bone cultures. In four patients (9%) with culture-positive soft-tissue specimens, bone culture specimens remained sterile. In one patient (2%) with culture-positive bone specimen, soft-tissue specimen remained sterile. Conclusion: Culture specimens should be obtained from both the bone and the overlying deep soft tissue in patients with suspected osteomyelitis whose clinical conditions are suitable. The decision to administer antibiotic therapy should depend on these results. (J Am Podiatr Med Assoc 98(4): 290–295, 2008)

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