J M Banzon1, S J Rehm2, S M Gordon2, S T Hussain3, G B Pettersson3, N K Shrestha4. 1. Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA. Electronic address: banzonj@ccf.org. 2. Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA. 3. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA. 4. Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA. Electronic address: shrestn@ccf.org.
Abstract
OBJECTIVES: Propionibacterium acnes remains a rare cause of infective endocarditis (IE). It is challenging to diagnose due to the organism's fastidious nature and the indolent presentation of the disease. The purpose of this study was to describe the clinical presentation and management of P. acnes IE with an emphasis on the methods of diagnosis. METHODS: We identified patients from the Cleveland Clinic Infective Endocarditis Registry who were admitted from 2007 to 2015 with definite IE by Duke Criteria. Propionibacterium acnes was defined as the causative pathogen if it was identified in at least two culture specimens, or identified with at least two different modalities: blood culture, valve culture, valve sequencing or histopathological demonstration of microorganisms. RESULTS: We identified 24 cases of P. acnes IE, 23 (96%) of which were either prosthetic valve endocarditis or IE on an annuloplasty ring. Invasive disease (71%) and embolic complications (29%) were common. All but one patient underwent surgery. Propionibacterium acnes was identified in 12.5% of routine blood cultures, 75% of blood cultures with extended incubation, 55% of valve cultures, and 95% of valve sequencing specimens. In 11 of 24 patients (46%), no causative pathogen would have been identified without valve sequencing. CONCLUSIONS: Propionibacterium acnes almost exclusively causes prosthetic valve endocarditis and patients often present with advanced disease. The organism may not be readily cultured, and extended cultures appear to be necessary. In patients who have undergone surgery, valve sequencing is most reliable in establishing the diagnosis.
OBJECTIVES:Propionibacterium acnes remains a rare cause of infective endocarditis (IE). It is challenging to diagnose due to the organism's fastidious nature and the indolent presentation of the disease. The purpose of this study was to describe the clinical presentation and management of P. acnes IE with an emphasis on the methods of diagnosis. METHODS: We identified patients from the Cleveland Clinic Infective Endocarditis Registry who were admitted from 2007 to 2015 with definite IE by Duke Criteria. Propionibacterium acnes was defined as the causative pathogen if it was identified in at least two culture specimens, or identified with at least two different modalities: blood culture, valve culture, valve sequencing or histopathological demonstration of microorganisms. RESULTS: We identified 24 cases of P. acnes IE, 23 (96%) of which were either prosthetic valve endocarditis or IE on an annuloplasty ring. Invasive disease (71%) and embolic complications (29%) were common. All but one patient underwent surgery. Propionibacterium acnes was identified in 12.5% of routine blood cultures, 75% of blood cultures with extended incubation, 55% of valve cultures, and 95% of valve sequencing specimens. In 11 of 24 patients (46%), no causative pathogen would have been identified without valve sequencing. CONCLUSIONS:Propionibacterium acnes almost exclusively causes prosthetic valve endocarditis and patients often present with advanced disease. The organism may not be readily cultured, and extended cultures appear to be necessary. In patients who have undergone surgery, valve sequencing is most reliable in establishing the diagnosis.
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: Silvia Limonta; Emmanuelle Cambau; Marie-Line Erpelding; Caroline Piau-Couapel; François Goehringer; Patrick Plésiat; Matthieu Revest; Véronique Vernet-Garnier; Vincent Le Moing; Bruno Hoen; Xavier Duval; Pierre Tattevin Journal: Open Forum Infect Dis Date: 2020-04-13 Impact factor: 3.835