Persistent Cutibacterium (Formerly Propionibacterium) acnes Bacteremia and Refractory Endocarditis in a Patient with Retained Implantable Pacemaker Leads

Abstract

Cutibacterium (formerly Propionibacterium) acnes (C. acnes) is a commensal bacteria commonly found on the human skin and in the mouth. While the virulence of C. acnes is low in humans, it does produce a biofilm and has been identified as an etiologic agent in a growing number of implant-associated infections. C. acnes infections can prove diagnostically challenging as laboratory cultures can often take greater than 5 days to yield positive results, which are then often disregarded as contaminant. Patients with recurrent bacteremia in the setting of implantable devices warrant further studies to evaluate for an associated valvular or lead endocarditis. The patient in this report demonstrates how cardiac device-related endocarditis secondary to C. acnes can be overlooked due to the indolent nature of this pathogen. This patient presented with an implanted cardiac pacemaker device, as well as retained leads from a prior pacemaker. Transesophageal echocardiography was required to confirm the diagnosis in the setting of multiple positive blood cultures and negative transthoracic echocardiograms over a period of 4 years. The purpose of this report is to highlight the difficulties encountered in diagnosing C. acnes endocarditis in a patient with a cardiac implantable electronic device and persistently positive blood cultures.

Prospective Study of the Detection of Bacterial Pathogens in Pediatric Clinical Specimens Using the Melting Temperature Mapping Method

“…Upon further investigation of the culture method results from the same infectious site, eight samples from seven patients were considered true pathogens, whereas five specimens from five patients were verified using the culture method results using samples from other sites. We also identified 16 specimens from 14 patients as possible pathogens, of which the results associated with two specimens were confirmed by identifying the same pathogen at the same infectious site using 16S rDNA sequencing, and the results of 14 specimens were supported by case reports of infections due to Corynebacterium xerosis ( 8 – 10 ), Cutibacterium acnes ( Propionibacterium acnes ) ( 11 – 13 ), Staphylococcus haemolyticus ( 14 – 16 ), and Staphylococcus warneri ( 17 – 19 ) in patients with sepsis or bacteremia. In addition, fastidious or noncultivable organisms, namely, Clostridium butyricum ( 20 , 21 ), Finegoldia magna ( 22 , 23 ), and Fusobacterium nucleatum ( 24 , 25 ), were detected in necrotizing enterocolitis, urinary tract infection, and sepsis, respectively.…”

A review on antimicrobial strategies in mitigating biofilm-associated infections on medical implants

“…The presence of biofilms can cause clinical indications of infection, such as swelling and redness in the area surrounding the pacemaker site or within the pacemaker pocket ( Döring et al, 2018 ). Additionally, other diseases such as sepsis, pneumonia, and abscess formation are caused by biofilms ( Caldara et al, 2022 ; Cámara et al, 2022 ; Freedman et al, 2020 ).…”

A Journey on the Skin Microbiome: Pitfalls and Opportunities

“…Different strains of C. acnes have been previously implicated in a plethora of diseases, including acne (see below). Its role as an opportunistic pathogen, especially in post-surgery wound infections, is becoming more prominent as well [ 37 , 38 , 39 ].…”