Richard van Valen1, Robert A F de Lind van Wijngaarden2, Nelianne J Verkaik3, Mostafa M Mokhles2, Ad J J C Bogers2. 1. Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands r.vanvalen@erasmusmc.nl. 2. Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands. 3. Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, Netherlands.
Abstract
OBJECTIVES: To study the characteristics of patients with Propionibacterium acnes prosthetic valve endocarditis (PVE) who required surgery. METHODS: A single-centre retrospective cohort study was conducted during a 7-year period. Patients with definite infective P. acnes endocarditis, according to the modified Duke criteria, were included. An extended culture protocol was applied. Information on medical health status, surgery, antibiotic treatment and mortality was obtained. RESULTS: Thirteen patients fulfilled the criteria for P. acnes endocarditis (0.53% of 2466 patients with valve replacement in a 7-year period). All patients were male and had a previous valve replacement. The health status of patients was poor at diagnosis of P. acnes PVE. Most patients (11 of 13, 85%) were admitted with signs of heart failure due to a significant paravalvular leak; 2 of 13 (15%) patients presented with septic emboli. Twelve patients needed redo surgery, whereas one could be treated with antibiotic therapy only. The time between the index surgery and presentation with P. acnes PVE varied between 5 and 135 months (median 26.5 months). Replacement and reconstruction of the dysfunctional valve and affected anatomical structures was mainly performed with a mechanical valve (n = 5, 42%) or a (bio-) Bentall prosthesis (n = 6, 50%). Antibiotic therapy consisted of penicillin with or without rifampicin for 6 weeks after surgery. The mortality in this series was low (n = 1, 8%) and no recurrent endocarditis was found during a median follow-up of 38 months. CONCLUSIONS: Propionibacterium acnes PVE is a rare complication after valve surgery. Redo surgery is often required. Treatment of the dysfunctional prosthetic aortic valve most often consists of root replacement, in combination with antibiotic therapy.
OBJECTIVES: To study the characteristics of patients with Propionibacterium acnes prosthetic valve endocarditis (PVE) who required surgery. METHODS: A single-centre retrospective cohort study was conducted during a 7-year period. Patients with definite infective P. acnes endocarditis, according to the modified Duke criteria, were included. An extended culture protocol was applied. Information on medical health status, surgery, antibiotic treatment and mortality was obtained. RESULTS: Thirteen patients fulfilled the criteria for P. acnes endocarditis (0.53% of 2466 patients with valve replacement in a 7-year period). All patients were male and had a previous valve replacement. The health status of patients was poor at diagnosis of P. acnes PVE. Most patients (11 of 13, 85%) were admitted with signs of heart failure due to a significant paravalvular leak; 2 of 13 (15%) patients presented with septic emboli. Twelve patients needed redo surgery, whereas one could be treated with antibiotic therapy only. The time between the index surgery and presentation with P. acnes PVE varied between 5 and 135 months (median 26.5 months). Replacement and reconstruction of the dysfunctional valve and affected anatomical structures was mainly performed with a mechanical valve (n = 5, 42%) or a (bio-) Bentall prosthesis (n = 6, 50%). Antibiotic therapy consisted of penicillin with or without rifampicin for 6 weeks after surgery. The mortality in this series was low (n = 1, 8%) and no recurrent endocarditis was found during a median follow-up of 38 months. CONCLUSIONS:Propionibacterium acnes PVE is a rare complication after valve surgery. Redo surgery is often required. Treatment of the dysfunctional prosthetic aortic valve most often consists of root replacement, in combination with antibiotic therapy.
Authors: F Roques; S A Nashef; P Michel; E Gauducheau; C de Vincentiis; E Baudet; J Cortina; M David; A Faichney; F Gabrielle; E Gams; A Harjula; M T Jones; P P Pintor; R Salamon; L Thulin Journal: Eur J Cardiothorac Surg Date: 1999-06 Impact factor: 4.191
Authors: J S Li; D J Sexton; N Mick; R Nettles; V G Fowler; T Ryan; T Bashore; G R Corey Journal: Clin Infect Dis Date: 2000-04-03 Impact factor: 9.079
Authors: C H Cabell; K K Pond; G E Peterson; D T Durack; G R Corey; D J Anderson; T Ryan; A S Lukes; D J Sexton Journal: Am Heart J Date: 2001-07 Impact factor: 4.749
Authors: Imad M Tleyjeh; Ahmed Abdel-Latif; Hazim Rahbi; Christopher G Scott; Kent R Bailey; James M Steckelberg; Walter R Wilson; Larry M Baddour Journal: Chest Date: 2007-09 Impact factor: 9.410
Authors: Tahaniyat Lalani; Vivian H Chu; Lawrence P Park; Enrico Cecchi; G Ralph Corey; Emanuele Durante-Mangoni; Vance G Fowler; David Gordon; Paolo Grossi; Margaret Hannan; Bruno Hoen; Patricia Muñoz; Hussien Rizk; Souha S Kanj; Christine Selton-Suty; Daniel J Sexton; Denis Spelman; Veronica Ravasio; Marie Françoise Tripodi; Andrew Wang Journal: JAMA Intern Med Date: 2013-09-09 Impact factor: 21.873
Authors: Walter Wilson; Kathryn A Taubert; Michael Gewitz; Peter B Lockhart; Larry M Baddour; Matthew Levison; Ann Bolger; Christopher H Cabell; Masato Takahashi; Robert S Baltimore; Jane W Newburger; Brian L Strom; Lloyd Y Tani; Michael Gerber; Robert O Bonow; Thomas Pallasch; Stanford T Shulman; Anne H Rowley; Jane C Burns; Patricia Ferrieri; Timothy Gardner; David Goff; David T Durack Journal: J Am Dent Assoc Date: 2007-06 Impact factor: 3.634
Authors: Daniel R Martin; James C Witten; Carmela D Tan; E Rene Rodriguez; Eugene H Blackstone; Gosta B Pettersson; Deborah E Seifert; Belinda B Willard; Suneel S Apte Journal: JCI Insight Date: 2020-07-23
Authors: Havard Dalen; Torbjørn Graven; Katrine H Slagsvold; Lars Erik Krogstad; Lars Mølgaard Saxhaug; Tomas D Tannvik; Espen Holte; Dag Ole Nordhaug; Øystein Karlsen; Anders Thorstensen; Alexander Wahba; Anders M Winnerkvist Journal: Eur Heart J Case Rep Date: 2022-03-02
Authors: Anna Both; Till O Klatte; Andreas Lübke; Henning Büttner; Maximilian J Hartel; Lars G Grossterlinden; Holger Rohde Journal: Acta Orthop Date: 2018-06-27 Impact factor: 3.717
Authors: Sophia L Alexis; Aaqib H Malik; Isaac George; Rebecca T Hahn; Omar K Khalique; Karthik Seetharam; Deepak L Bhatt; Gilbert H L Tang Journal: J Am Heart Assoc Date: 2020-08-08 Impact factor: 5.501