Table 1.
Included cases of Corynebacterium PJI
| Study | Weller et al. [15], 1994 Case 1 |
Case 2 | Yildiz S et al. [16], 1995 | Tleyjeh et al. [17], 2005 | Achermann et al. [18], 2009 | Wee et al. [19], 2013 | Streubel et al. [20], 2016 Case 1 |
Case 2 | Case 3 | Ferry et al. [21], 2017 | Fernández-Esgueva et al. [22], 2019 | Hernandez et al. [23], 2020 Case 1 |
x Case 2 |
x Case 3 |
Case 4 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Country, Region | U.K., Oxford | U.K., Oxford | Turkey, Ankara | USA, Rochester | Switzerland, Zurich | Singapore, Singapore | USA, Omaha | USA, Omaha | USA, Omaha | France, Lyon | Spain, Zaragoza | USA, Durham | USA, Durham | USA, Durham | USA, Durham |
| PJI type | Hip | Hip | Knee | Hip | Shoulder | Elbow | Elbow | Elbow | Elbow | Knee | Knee | Hip | Hip | Hip | Knee |
| Age (years) | 52 | 44 | 67 | 78 | 62 | 67 | 39 | 61 | 54 | 54 | 85 | 69 | 77 | 72 | 63 |
| Sex | Female | Male | Female | Male | Female | Female | Female | Female | Male | NA | Female | Female | Female | Female | Male |
| BMI (kg/m2) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 30 | 37 | 36.13 | 40 |
| CCI | NA | NA | NA | NA | NA | NA | 1 | NA | 1 | 2 | 6 | 3 | 3 | 4 | 5 |
| Secondary diseases | NA | NA | NA | Multiple | NA | NA | Rheumatoid arthritis | NA | Post-traumatic arthritis | Hemophilia, hepatitis C | Hypertension, chronic atrial fibrillation, asthma, breast cancer | Rheumatoid arthritis | Atrial fibrillation, bilateral TKA | Rheumatoid arthritis | Diabetes, stroke, tobacco use |
| Primary implantation (PI) | 1986 | 1974 | 1988 | 2002 | 2007 | NA | NA | NA | NA | NA | 2000 | 2017 | 2011 | 2012 | 2015 |
| Indication for PI | NA | Osteoarthritis | Osteoarthritis | NA | Secondary arthrosis | NA | NA | NA | NA | NA | Osteoarthritis | NA | NA | NA | Osteoarthritis |
| Year of initial PJI | 1992 | 1992 | 1994 | 2002 | 2008 | NA | NA | NA | NA | 2015 | 2016 | 2017 | 2013 | 2015 | 2018 |
| Microbe identified in PJI prior to Corynebacterium PJI | NA | NA | NA | NA | NA | NA | NA | NA | NA | Klebsiella pneumoniae, Staphylococcus aureus | - | NA | NA | E. coli, VRE, Proteus vulgaris, Serratia marcescens | NA |
| Year of initial Corynebacterium PJI | 1992 | 1992 | 1994 | 2004 | 2008 | NA | NA | NA | NA | 2016 | 2016 | 2017 | 2019 | 2018 | 2018 |
| Corynebacterium species | C. jeikeium | C. jeikeium | C. jeikeium | C. jeikeium | C. bovis | C. spp. | C. spp. | C. spp | C. spp | C. striatum | C. striatum | C. striatum | C. striatum | C. striatum | C. striatum |
| Coexisting microbe/Polymicrobial | None | None | None | CNS | None | None | NA | NA | MSSA, MRSA, CNS | Enterobacter asburiae | None | None | Mycobacterium avius | None | None |
| Onset type | Chronic onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset | NA | NA | NA | NA | Chronic onset | Chronic onset | Acute onset | Chronic onset | Chronic onset | Chronic onset |
| Initial diagnosis | Tissue samples | Tissue samples | Joint aspiration | Joint aspiration | Joint aspiration | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Joint aspiration | Tissue samples | Tissue samples | Tissue samples | Tissue samples |
| CRP | NA | NA | NA | High CRP | 0.7 mg/dl | NA | NA | NA | NA | NA | 10.93 mg/dl | 24 mg/dl | 12.71 mg/dl | 17.9 mg/dl | 1.91 mg/dl |
| ESR | NA | NA | NA | High ESR | 22 mm/hr | NA | NA | NA | NA | NA | NA | 100 mm/hr | 90 mm/hr | 108 mm/hr | 100 mm/hr |
| Leading symptoms | Pain, persistent discharging sinus tract | Sinus tract | Disabling pain | Local inflammation signs | Pain, stiffness | NA | NA | NA | NA | Bloody discharge | Local signs of inflammation, pain, limited flexion | Local inflammation signs | Local inflammation signs, draining sinus tract | Sinus tract | 15-degree flexion contracture |
| Intraoperative histopathology | Acute and chronic inflammatory changes | NA | NA | Krenn and Morawitz II | Krenn and Morawitz III | No acute inflammation | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Initial surgical treatment for Corynebacterium PJI | Two-stage exchange | Two-stage exchange | Two-stage exchange | I&D, revision of the acetabular component | Two-stage exchange | None (identified during revision) | Two times I&D | Two times I&D | Two times I&D |
None, instead antibiotic treatment (due to high risk of potential bleeding); After 3 months resection |
NA | DAIR | Two-stage exchange | I&D | Two-stage exchange |
| Prosthesis reimplantation/ prosthesis in situ | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | No | Yes | No | Yes |
| Total treatment for Corynebacterium PJI |
Vancomycin 42 days |
Vancomycin 42 days |
Vancomycin 35 days + Tetracycline 56 days |
Vancomycin 42 days |
Imipenem, followed by oral Amoxicillin 84 days |
Cephalexin 14 days |
Amoxicillin Duration NA |
Vancomycin Duration NA |
Vancomycin Duration NA |
Vancomycin + Imipenem + Fosfomycin 84 days |
Vancomycin + Ceftazidime 5 days; later 9 days i.v. Linezolid |
Vancomycin 42 days |
Vancomycin + Ertapenem 56 days |
Tedizolid (Vancomycin resistant organism) 56 days |
Vancomycin 42 days |
| Outcome of initial treatment | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | Reinfection without pathogen detection I&D | Periprosthetic fracture treated with open reduction and internal fixation | No clinical signs of infection | New infection due to E. asburiae Resection arthroplasty | No clinical signs of infection | Reinfection due to C. striatum Resection arthroplasty | Dislocation (subsequent infection; couned as aseptic revision) | Reinfection due to C. striatum and E. faecium I&D | No clinical signs of infection |
| Follow-up | 12 months | 12 months | 7 months | 6 months | 2.5 months | 67 months | 72 months | 204 months | 24 months | 9 months | NA | 30 months | 9 months | 14 months | 13 months |
| Perioperative complications | NA | NA | None | None | Central bone necrosis of the humerus | NA | None | None | Complex regional pain syndrome | Hematoma with bloody discharge, hemorrhagic discharge | None | None | None | None | None |
| Death by PJI | No | No | No | No | No | No | No | No | No | No | No | No | No | No | No |
| Study | Case 5 | Case 6 | Streifel et al. [24], 2022 | Tabaja et al. [25], 2022 Case 1 |
Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | Case 7 | Case 8 | Case 9 | Case 10 | Case 11 | Case 12 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Country, Region | USA, Durham | USA, Durham | USA, Portland | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester |
| PJI type | Knee | Knee | Knee | Knee | Knee | Knee | Knee | Hip | Knee | Knee | Knee | Knee | Knee | Knee | Hip |
| Age (years) | 70 | 66 | 65 | 79 | 91 | 60 | 82 | 40 | 59 | 75 | 58 | 65 | 50 | 59 | 63 |
| Sex | Female | Male | Male | Male | Male | Male | Female | Female | Male | Male | Female | Female | Male | Male | Female |
| BMI (kg/m2) | 28.8 | 24.13 | NA | 25.8 | 32.2 | 32.3 | 36 | 34.6 | 62 | 36.4 | 29.8 | 37 | 21.9 | 42.4 | 20 |
| CCI | 5 | 4 | NA | 3 | 6 | 3 | 11 | 0 | 2 | 3 | 3 | 9 | 2 | 4 | 3 |
| Secondary diseases | Rheumatoid arthritis, diabetes, hypoalbuminemia | Rheumatoid arthritis, olecranon septic bursitis | NA | Coronary artery disease, chronic left lower extremity ulcer | Chronic kidney disease | Diabetes | Chronic artery disease, diabetes, congestive heart failure, chronic kidney disease, peripheral artery disease, Hodgkin-lymphoma | Teratologic hip dislocation | Congestive heart failure | Chronic artery disease | Chronic kidney disease | Liver cirrhosis, diabetes, congestive heart failure, chronic right lower extremity ulcer, chronic kidney disease | Klipperl-trenaunay syndrome, asplenia | Coronary artery disease, congestive heart failure, chronic kidney disease, chronic left lower extremity ulcer | Rheumatoid arthritis, morbus Crohn, immunosuppressive medications |
| Primary implantation (PI) | 2018 | 2015 | 1980 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Indication for PI | Osteoarthritis | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Year of initial PJI | 2018 | NA | 2008 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Microbe identified in PJI prior to Corynebacterium PJI | - | Pseudomonas aeruginosa, Staphylococcus warneri, Staphylococcus epidermidis | Stpahylococcus hominis, Dermacoccus spp. | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | MSSA | NA |
| Year of initial Corynebacterium PJI | 2018 | 2018 | 2008 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Corynebacterium species | C. striatum | C. striatum | C. striatum | C. striatum | C. striatum | C. striatum | C. striatum | C. amycolatum | C. jeikeium | C. striatum | C. striatum | C. striatum | C. jeikeium | C. striatum | C. striatum |
| Coexisting microbe/Polymicrobial | Peptoniphilus asaccharolyticus, Prevotella bivia | None | Staphylococcus haemolyticus, Staphylococcus epidermidis | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Onset type | Acute onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset | Acute onset | Chronic onset | Acute onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset |
| Initial diagnosis | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples |
| CRP | 35 mg/dl | 43.9 mg/dl | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| ESR | 116 mm/hr | 65 mm/hr | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Leading symptoms | Wound dehiscence, purulent drainage, fever | Sinus tract, non-healing wound | Persistent drainage | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Intraoperative histopathology | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Initial surgical treatment for Corynebacterium PJI | DAIR | Resection arthroplasty | I&D | DAIR | DAIR | DAIR | DAIR | DAIR | DAIR | DAIR | Two-stage exchange | Two-stage exchange | Two-stage exchange | Two-stage exchange | Two-stage exchange |
| Prosthesis reimplantation/ prosthesis in situ | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Total treatment for Corynebacterium PJI |
Vancomycin + Piperacillin-Tazobactam 14 days |
Vancomycin 42 days |
Daptomycin 33 days, Linezolid 2 days |
Doxycycline 350 days |
Amoxicillin + Minocycline 14 days |
49 days Vancomycin + 91 days minocycline |
Vancomycin 49 days |
Daptomycin 28 days |
Daptomycin + Ertapenem 42 days |
Vancomycin 42 days |
Vancomycin 42 days |
NA |
Vancomycin 42 days |
Vancomycin 42 days |
Vancomycin + Ertapenem 98 days |
| Outcome of initial treatment | Reinfection due to C. striatum Resection arthroplasty | Above knee amputation without pathogen detection | Reinfection due to C. striatum DAIR | Reinfection due to C. striatum Two-stage exchange | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | Chronic sinus tract with culture negative DAIR | No clinical signs of infection | No clinical signs of infection | Reinfection with culture negative DAIR | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection |
| Follow-up in months | 11 months | 12 months | 12 months | 12 months | 7 months | 18 months | 4 months | 23 months | 6 months | 11 months | 79 months | 24 months | 75 months | 39 months | 15 months |
| Perioperative complications | Increased left lower extremity pain and darkening of her toes | None | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Death by PJI | Yes | No | No | No | No | No | No | No | No | No | No | No | No | No | No |
| Study | Case 13 | Case 14 | Case 15 | Case 16 | Case 17 | Case 18 | Case 19 | Panuu et al. [26], 2022 Case 1—3 |
Case 4 | Case 5 | Case 6—7 | Case 8—10 | Case 11—14 | Case 15 | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Country, Region | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Rochester | USA, Cleveland | USA, Cleveland | USA, Cleveland | USA, Cleveland | USA, Cleveland | USA, Cleveland | USA, Cleveland | ||||||||||||||
| PJI type | Knee | Hip | Knee | Hip | Knee | Hip | Knee | Hip | Hip | Hip | Knee | Knee | Knee | Knee | ||||||||||||||
| Age (years) | 55 | 69 | 68 | 57 | 85 | 69 | 65 | NA | ||||||||||||||||||||
| Sex | Female | Male | Female | Male | Male | Female | Male | NA | ||||||||||||||||||||
| BMI (kg/m2) | 25.5 | 32 | 33.5 | 31.3 | 27.9 | 26.1 | 42.8 | NA | ||||||||||||||||||||
| CCI | 2 | NA | 3 | 5 | 7 | 7 | 3 | NA | ||||||||||||||||||||
| Secondary diseases | Rheumatoid arthritis, marfan syndrome, immunosuppressive medications | NA | Rheumatoid arthritis, Sjogren syndrome | Diabetes, chronic kidney disease, COPD, ataxia | Coronary artery disease, diabetes, colon carcinoma | Peripheral artery disease, chronic kidney disease, localized bladder carcinoma | Diabetes, chronic inflammatory demyelinating polyneuropathy, immunosuppressive medications | NA | ||||||||||||||||||||
| Primary implantation (PI) | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Indication for PI | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Year of initial PJI | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Microbe identified in PJI prior to Corynebacterium PJI | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Year of initial Corynebacterium PJI | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Corynebacterium species | C. jeikeium | C. amycolatum | C. jeikeium | C. striatum | C. striatum | C. striatum | C. striatum | C. striatum | ||||||||||||||||||||
| Coexisting microbe/Polymicrobial | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Onset type | Chronic onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset | Chronic onset | NA | ||||||||||||||||||||
| Initial diagnosis | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | Tissue samples | NA | ||||||||||||||||||||
| CRP | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| ESR | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Leading symptoms | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Intraoperative histopathology | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Initial surgical treatment for Corynebacterium PJI | Two-stage exchange | Two-stage exchange | Two-stage exchange | Two-stage exchange | Resection arthroplasty with spacer insertion | Resection arthroplasty with residual cerclage wires | Resection arthroplasty with spacer insertion | Two-stage exchange | Resection with spacer insertion | Girdlestone | Resection with spacer insertion | Two-stage exchange | I&D | I&D | ||||||||||||||
| Prosthesis reimplantation/ prosthesis in situ | Yes | Yes | Yes | Yes | No | No | No | Yes | No | No | No | Yes | Yes | No | ||||||||||||||
| Total treatment for Corynebacterium PJI |
Vancomycin 42 days |
Vancomycin 42 days |
daptomycin + Ertapenem 42 days |
Vancomycin 42 days |
Vancomycin 56 days |
Meropenem 56 days |
Vancomycin 42 days |
Combination of Vancomycin, Cephalosporines, Penicillin, Beta-lactam, Doxycycline, Carbapenems, Fluocinolones 81.4 ± 97.8 days |
Combination of Vancomycin, Aminoglycosides, Carbapenems, Cephalosporine, Doxycycline 50 days |
Combination of Piperacillin-Tazobactam, Vancomycin. Cephalosporines 40 days |
Combination of Vancomycin, Cephalosporines, Carbapenems, Penicillin 26.5 ± 7.8 days |
Combination of Vancomycin, Cephalosporines, Daptomycin, Penicillin, Beta-lactam, Fluconazole (1 case) 71.3 ± 70.3 days |
Combination of Vancomycin, Cephalosporines, Penicillin + Beta-lactam, Daptomycin, Doxycycline, Fluorchinolones 27 ± 32.1 days |
Combination of Daptomycin, Doxycycline, Rifampin, Ciprofloxacin, Linezolid 172 days |
||||||||||||||
| Outcome of initial treatment | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection | No clinical signs of infection |
New infection due to: Case 1: VRE, E. faecium, C. albicans I&D Case 2: Proteus mirabilis DAIR Case 3: VRE Resection arthroplasty |
New infection due to MRSA I&D |
No clinical signs of infection |
Case 6: New infection due to VRE Above knee amputation Case 7: No clinical signs of infection |
Case 8: Infection with culture negative Revision arthroplasty Case 9–10: No clinical signs of infection |
Case 11: Reinfection due to C. striatum Above knee amputation Case 12–14: No clinical signs of infection |
Reinfection due to C. striatum and Enterobacter cloacae Resection arthroplasty | ||||||||||||||
| Follow-up in months | 6 months | 67 months | 15 months | 55 months | 29 months | 54 months | 31 months | 33.7 ± 24.2 months | 17.4 months | 42.5 months | 34.9 ± 14 months | 11.7 ± 1.9 months | 41.9 ± 22.8 months | 7 months | ||||||||||||||
| Perioperative complications | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||||||
| Death by PJI | No | No | No | No | No | No | No | No | No | No | No | No | No | No | ||||||||||||||