Corynebacterium striatum is a commensal of skin and mucous membranes, usually a contaminant, that has stood out as an opportunistic pathogen in several severe infections. Its role in prosthetic joint infection was very rare, with only 11 cases described up to 2018, but it has been emerging as a pathogen in recent years in these cases. We report the case of a 71-year-old female patient, obese, smoker, with a history of breast cancer and knee osteoarthritis. She was hospitalized in February 2025 for chronic elbow bursitis. Subsequently, she was hospitalized in May for total right knee arthroplasty. She received preemptive treatment for 10 days with cefepime and daptomycin due to partially controlled chronic elbow bursitis caused by Staphylococcus epidermidis and the presence of important risk factors for prosthesis infection (PJI risk score 2.43%). One week after the end of treatment, she developed knee pain and edema, but arthrocentesis showed low cellularity (1,440 cells, 67% neutrophils), and culture and molecular panel (BIOFIRE® Joint Infection (JI) Panel) were negative. She was then discharged. About 10 days later, she returned with intense pain, hyperemia, and serous drainage from the knee. In addition to high clinical suspicion of infection already during the previous admission, a clinical diagnosis of prosthetic joint infection was assumed. A knee prosthesis revision was performed with sonication of the polyethylene component, and tissue and secretion were collected for culture; a negative pressure dressing was placed. Cefepime and daptomycin were started until culture results. C. striatum was identified in five of them, in addition to the sonicate, with the following profile: susceptible to vancomycin, linezolid, and rifampin; resistant to penicillin (MIC 3 mg/mL), ciprofloxacin, and doxycycline. Treatment was adjusted to linezolid and rifampin, and daptomycin susceptibility testing was requested. Contrary to the profile usually found in the literature, the gradient strip showed susceptibility (MIC 0.094 mg/mL) to daptomycin. The antimicrobial regimen with linezolid and rifampin was maintained, and the patient remains hospitalized to date. We highlight the limitation of the molecular panel in this case for not including C. striatum . It is also important to highlight the risk of failure with daptomycin due to development of resistance during treatment, with reports of high-level resistance (MIC >256 μg/mL) in isolates exposed to daptomycin for 24 hours, as well as increased risk of rhabdomyolysis when used at high doses.
Fonseca et al. (Sun,) studied this question.