<i>Propionibacterium acnes</i> Endocarditis of a Prosthetic Aortic Valve

List, Richard J.; Sheikh, Nabeel; Theologou, Thomas; Mitchell, Ian M.; Mathew, Thomas

doi:10.1002/clc.20492

Cited by 10 publications

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“…Propionibacterium acnes is recognized as an agent of infection of prosthetic devices, such as ventriculoperitoneal shunts and prosthetic heart valves (2,5,14,18). The importance of this Gram-positive, non-spore-forming, anaerobic bacterium as an agent of PJI is increasingly appreciated (6,13,15,24).…”

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Optimization of Periprosthetic Culture for Diagnosis of Propionibacterium acnes Prosthetic Joint Infection

et al. 2011

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Propionibacterium acnes is increasingly recognized as an important agent of prosthetic joint infection (PJI).However, the optimum culture conditions for recovery of this organism from PJI specimens have not been determined. By applying a prolonged 28-day culture incubation to all periprosthetic specimens received for bacterial culture from 198 revision arthroplasty procedures, we retrospectively determined that a 13-day culture incubation period is necessary for the recovery of P. acnes from patients with PJI. Incubation beyond this period was associated with increasing recovery of nondiagnostic isolates: 21.7% of P. acnes isolates believed to be clinically unimportant were recovered after 13 days of incubation. Importantly, a diagnosis of P. acnes PJI would have been missed in 29.4% of patients had extended culture incubation been applied only to anaerobic culture media. Although specimens from P. acnes PJIs were more commonly associated with the presence of >2 culture media positive for growth, acute inflammation (>5 neutrophils/high-power field) was observed in only 40% of patients with PJIs that had more than one specimen submitted for bacterial culture. These results support the need for a minimum culture incubation period of 13 days to be applied to both aerobic and anaerobic culture media for all periprosthetic specimens. Optimal recovery of infecting organisms from PJI specimens will be an important component in generating a universal definition for PJI due to indolent agents of infection, such as P. acnes.

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Optimization of Periprosthetic Culture for Diagnosis of Propionibacterium acnes Prosthetic Joint Infection

et al. 2011

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“…infection. In addition to antimicrobial treatment, 81 % of the patient underwent cardiac surgery (due to the propensity of the organism to form an abscess [ 9 ]), and the overall mortality rate was 16 %[ 8 ]. The patient described above was cured with antibiotic therapy alone.…”

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Quantification of the antibody response to Propionibacterium acnes in a patient with prosthetic valve endocarditis: – a case report

2016

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BackgroundThe isolation of Propionibacterium acnes in blood cultures is often considered a contaminant. On rare occasions, P. acnes can cause severe infections, including endocarditis and intravascular prosthesis-associated infections. To evaluate the discrimination between a contaminant and a clinically relevant infection we used an Ouchterlony test system to quantify the antibody response to P. acnes in a patient with a proven P. acnes endocarditis.Case presentationWe report on a 64-year-old Caucasian man who developed P. acnes endocarditis four years following a composite valve-graft conduit replacement of the aortic root. Bacterial growth in blood cultures was detected after an incubation period of 6 days. However, the antibody titer to P. acnes was 1:8 at the time of diagnosis and declined slowly thereafter over 2½ years. The patient’s response to the antibiotic treatment was excellent, and no surgical re-intervention was necessary.ConclusionThe working hypothesis of infective endocarditis can be substantiated by serologic testing, which, if positive, provides one additional minor criterion. Moreover, quantification of the antibody response to P. acnes, though not specific, may assist in the differentiation between contaminants and an infection. This quantification may have implications for the patient management, e.g. indication for and choice of the antibiotic therapy.

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“…Det er høy risiko for abscessformasjon ved Propionebacterium acnes hos klaffeopererte, men det var ingen abscess i aortaroten hos vår pasient. Antibiotikabehandling alene anses sjelden som tilstrekkelig, og terskelen for kirurgi bør vaere lav (16).…”

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