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Cluster of Nontoxigenic Corynebacterium diphtheriae Infective Endocarditis and Rising Background C. diphtheriae Cases-Seattle, Washington, 2020-2023. | LitMetric

AI Article Synopsis

  • Nontoxigenic Corynebacterium diphtheriae can cause infective endocarditis (IE), as seen in five patients identified within a year at a Seattle hospital.
  • An analysis of health records from September 2020 to April 2023 revealed 44 cases, mostly after March 2022, predominantly affecting male, unstably housed individuals with a history of injecting drugs.
  • The outbreak shows high morbidity, with 77% of cases requiring hospitalization, and highlights a concerning trend in populations at risk, including multiple deaths among IE patients.

Article 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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093663PMC
http://dx.doi.org/10.1093/cid/ciae094DOI Listing

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