Propionibacterium avidum infection following breast reduction: high morbidity from a low-virulence pathogen

Abstract

Propionibacterium avidum is a common inhabitant of sebaceous glands, traditionally considered to be of low virulence and generally found on implanted foreign material. We report a rare case of P. avidum breast abscess, causing severe morbidity following breast reduction surgery. A 36-year-old woman presented with a non-painful wound discharge 3 weeks postoperatively, and was treated conservatively. She was readmitted 7 weeks postoperatively with a red and tender breast. A purulent discharging abscess was drained under ultrasound guidance. A 2-week intravenous course of amoxicillin–clavulanic acid, followed by oral replacement for a month resulted effective. Serial ultrasound imaging was useful in treatment decision-making. The infective potential of P. avidum may be underappreciated. Proximity of sutures to the axilla, tobacco smoking and the potential for resorbable sutures to host bacteria may predispose to infection, and should raise the clinician's awareness.

Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

“…acnes were usually described in IAI, C . avidum caused also infections in absence of foreign bodies such as splenic or perianal abscess [ 38 ] and infections after breast surgery without implant [ 39 – 41 ]. Interestingly, in our cohort we found twelve IAI caused by C .…”

Clinical and Biological Features of Cutibacterium (Formerly Propionibacterium)avidum, an Underrecognized Microorganism

“…In the first case, the only predisposing factor was surgery (165). Later, the same case was described by two teams, from Switzerland and Austria, revealing the role of this common skin colonizer, which is well known as a resident of the pilosebaceous follicle unit (15,17). The strain was the only etiology of an ulceration of the inframammary region with induration and putrid secretion.…”

“…In contrast, and to the best of my knowledge, among C. avidum isolates recovered in different contexts (from skin, blood, tissue, prostate, or abdomen) (201), macrolide resistance due to point mutations remains rare compared to that in C. acnes clinical strains, and no ermX gene has yet been described (51). Interestingly, the strains from the various published case reports (Table 5) were fully susceptible to antibiotics, except for clindamycin in two cases (15,17) with high-level resistance to clindamycin, as previously reported (51,202). The same observation was reported for clinical strains isolated during bone and joint infections (203).…”

“…Other Gram-positive pathogens are able to produce lipase, such as bacteria of the Burkholderia cepacia complex, with an impact in lung epithelial cell invasion (61), and Candida parapsilosis, a skin commensal for which lipase modulates the immune response of macrophages (62). Future studies clearly need to be performed to investigate the pathogenesis of C. avidum infection, especially in liponecrotic breast abscess or skin necrosis (15)(16)(17)32).…”

“…Although often defined as a commensal (12,13), C. avidum has likely been underestimated, unrecognized, and misidentified in more than a few clinical cases. Despite its low frequency in human infections, numerous associated or invasive infections have been reported: bone infections, infective endocarditis (IE), breast infections, abdominal infections, prostate infections, and splenic and skin abscesses have been described, sometimes with significant collateral damage for the patient (14)(15)(16)(17). In my experience, although one cannot avoid bias according to the identification method used and the awareness of microbiologists, there has been a clearly observed increase in C. avidum-positive samples over the past years.…”