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- Title
Cluster of Nontoxigenic Corynebacterium diphtheriae Infective Endocarditis and Rising Background C. diphtheriae Cases—Seattle, Washington, 2020–2023.
- Authors
Karmarkar, Ellora N; Fitzpatrick, Thomas; Himmelfarb, Sarah T; Chow, Eric J; Smith, Hayden Z; Lan, Kristine F; Matsumoto, Jason; Graff, Nicholas R; DeBolt, Chas; Truong, Thao; Bourassa, Lori; Farquhar, Carey; Fang, Ferric C; Kim, H Nina; Pottinger, Paul S
- Abstract
Background Nontoxigenic Corynebacterium diphtheriae , often associated with wounds, can rarely cause infective endocarditis (IE). Five patients with C. diphtheriae IE were identified within 12 months at a Seattle-based hospital system. We reviewed prior C. diphtheriae –positive cultures to determine if detections had increased over time and evaluated epidemiologic trends. Methods We conducted a formal electronic health record search to identify all patients aged ≥18 years with C. diphtheriae detected in a clinical specimen (ie, wound, blood, sputum) between 1 September 2020 and 1 April 2023. We collected patient demographics, housing status, comorbidities, substance-use history, and level of medical care required at detection. We extracted laboratory data on susceptibilities of C. diphtheriae isolates and on other pathogens detected at the time of C. diphtheriae identification. Results Between 1 September 2020 and 1 April 2023, 44 patients (median age, 44 years) had a C. diphtheriae– positive clinical culture, with most detections occurring after March 2022. Patients were predominantly male (75%), White (66%), unstably housed (77%), and had a lifetime history of injecting drugs (75%). Most C. diphtheriae –positive cultures were polymicrobial, including wound cultures from 36 (82%) patients and blood cultures from 6 (14%) patients, not mutually exclusive. Thirty-four patients (77%), including all 5 patients with C. diphtheriae IE, required hospital admission for C. diphtheriae or a related condition. Of the 5 patients with IE, 3 died of IE and 1 from COVID-19. Conclusions Findings suggest a high-morbidity outbreak disproportionately affecting patients who use substances and are unstably housed.
- Subjects
WASHINGTON (State); ANTIBIOTICS; SPUTUM microbiology; MICROBIOLOGY of wounds; BLOOD; SOFT tissue infections; COMMUNICABLE diseases; MICROBIAL sensitivity tests; INTRAVENOUS drug abuse; SKIN diseases; RESEARCH funding; SEX distribution; HOSPITAL care; INFECTIVE endocarditis; TREATMENT effectiveness; DESCRIPTIVE statistics; CELL culture; DIPHTHERIA; EPIDEMICS; MEDICAL records; ACQUISITION of data; DISEASE complications; SOCIODEMOGRAPHIC factors; HOUSING; MEDICAL needs assessment; CASE studies; COMORBIDITY; MIXED infections; COVID-19
- Publication
Clinical Infectious Diseases, 2024, Vol 78, Issue 5, p1214
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciae094