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McKesey J, Mazhar M, Alam M, Srivastava D, Nijhawan RI. Incidence of Bacteremia, Infective Endocarditis, or Prosthetic Joint Infection in Dermatologic Surgery: A Systematic Review. Dermatol Surg 2024; 50:428-433. [PMID: 38318842 DOI: 10.1097/dss.0000000000004101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Prophylactic antibiotic therapy is widely used in dermatologic surgery to prevent surgical site infections and bacteremia, which can lead to prosthetic joint infections (PJI) and infective endocarditis (IE) in high-risk populations. OBJECTIVE To evaluate the incidence of bacteremia, PJI, and IE after dermatologic surgery and assess the current evidence for antibiotic prophylaxis. MATERIALS AND METHODS A search of the computerized bibliographic databases was performed using key terms from the date of inception to March 21, 2021. Data extraction was performed independently by 2 data extractors. RESULTS The review resulted in 9 publications that met inclusion criteria, including 5 prospective cohort studies and 4 case reports or case series. The prospective studies reported a wide range of bacteremia incidence (0%-7%) after dermatologic surgery. No cases of PJI resulting directly from cutaneous surgery were identified, and only 1 case series reported IE after various skin procedures. CONCLUSION These findings suggest a low rate of bacteremia and a lack of direct evidence linking dermatologic surgery to PJI or IE. The scarcity of published data on this topic is a limitation, highlighting the need for further research, particularly randomized controlled trials, to guide antibiotic prophylaxis recommendations.
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Affiliation(s)
| | - Momina Mazhar
- University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Murad Alam
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Divya Srivastava
- University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Rajiv I Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas; and
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2
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Coenye T, Spittaels KJ, Achermann Y. The role of biofilm formation in the pathogenesis and antimicrobial susceptibility of Cutibacterium acnes. Biofilm 2022; 4:100063. [PMID: 34950868 PMCID: PMC8671523 DOI: 10.1016/j.bioflm.2021.100063] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/20/2022] Open
Abstract
Cutibacterium acnes (previously known as Propionibacterium acnes) is frequently found on lipid-rich parts of the human skin. While C. acnes is most known for its role in the development and progression of the skin disease acne, it is also involved in many other types of infections, often involving implanted medical devices. C. acnes readily forms biofilms in vitro and there is growing evidence that biofilm formation by this Gram-positive, facultative anaerobic micro-organism plays an important role in vivo and is also involved in treatment failure. In this brief review we present an overview on what is known about C. acnes biofilms (including their role in pathogenesis and reduced susceptibility to antibiotics), discuss model systems that can be used to study these biofilms in vitro and in vivo and give an overview of interspecies interactions occurring in polymicrobial communities containing C. acnes.
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Affiliation(s)
- Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
| | - Karl-Jan Spittaels
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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3
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Servito M, Fernández AL, Culhane S, Amador-Godoy Y, El-Diasty M. Occult prosthetic aortic valve endocarditis caused by Propionibacterium acnes: a case report. Ann R Coll Surg Engl 2022; 104:e216-e218. [PMID: 35446155 PMCID: PMC9246548 DOI: 10.1308/rcsann.2021.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present an unusual case of occult mechanical aortic valve endocarditis caused by Propionibacterium acnes (P. acnes), which occurred five years after the initial cardiac surgical procedure. The only potential source of this infection from the patient's past medical history was a gastric band removal followed by a gastric bypass surgery, which was performed two years prior to her redo cardiac procedure. The patient's main presenting symptom was progressive dyspnoea with worsening of gradients across the mechanical aortic valve. Of note, she had no cardinal symptoms of infection. The patient underwent redo bioprosthetic aortic valve replacement with aortic root replacement. Prosthetic valve cultures grew P. acnes, while blood cultures remained negative. She was started on intravenous antibiotics for six weeks and her postoperative course was uneventful. She remained symptom-free six months postoperatively. This case opens the discussion for the importance of administering antibiotics prophylaxis for endocarditis in patients with prosthetic heart valves undergoing gastric procedures.
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Affiliation(s)
- M Servito
- Kingston Health Science Centre, Kingston, Ontario, Canada
| | - AL Fernández
- Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - S Culhane
- Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Y Amador-Godoy
- Kingston Health Science Centre, Kingston, Ontario, Canada
| | - M El-Diasty
- Kingston Health Science Centre, Kingston, Ontario, Canada
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4
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True infection or contamination in patients with positive Cutibacterium blood cultures-a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2022; 41:1029-1037. [PMID: 35612767 PMCID: PMC9250478 DOI: 10.1007/s10096-022-04458-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
Cutibacterium is a genus often considered a contaminant when present in blood cultures, but it can also cause severe infections, especially related to implanted foreign materials. We investigated the incidence and features of patients with true Cutibacterium infection. Patients with positive Cutibacterium blood cultures between the years 2015-2020 in southern Sweden were identified through microbiology records and medical records were studied retrospectively. Cutibacterium isolates were species determined using MALDI-TOF MS. Patients were classified as having true infection or contamination according to a definition considering both clinical and microbiological features and these groups were compared. A total of 313 episodes of positive Cutibacterium blood cultures were identified in 312 patients. Of these, 49 (16%, corresponding to an incidence of 6 cases per million inhabitants per year) were classified as true infections. The most common species was Cutibacterium acnes (87%), and the majority were elderly men with comorbidities. Patients with true Cutibacterium infection often had an unknown focus of infection (n = 21) or a focus in the respiratory tract (n = 18). We identified one episode of ventriculo-peritoneal shunt infection, three episodes of aortic stent-graft infection, and one episode of infective endocarditis. Two patients, where Cutibacterium was isolated at the site of infection, had only one positive blood culture. The finding of positive Cutibacterium blood cultures should not always be considered contamination. Definitions of true Cutibacterium bacteremia with a demand that more than one blood culture must be positive may miss true infections.
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5
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Abdelhamid AA, Kobayashi T, Tholany J, Sekar P. Recurrent Cutibacterium acnes prosthetic valve endocarditis. BMJ Case Rep 2021; 14:14/7/e243878. [PMID: 34326116 PMCID: PMC8323374 DOI: 10.1136/bcr-2021-243878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 29-year-old man with a history of congenital aortic stenosis and mechanical aortic valve replacement with previous Cutibacterium acnes prosthetic valve endocarditis (PVE) presented with a 2-week history of fevers and night sweats. Transoesophageal echocardiogram revealed a 0.6 cm×0.5 cm vegetation on the mechanical aortic valve. An anaerobic blood culture became positive for C. acnes 6 days after the blood cultures were obtained. He did not have any surgical intervention. He was successfully treated with 6 weeks of ceftriaxone, followed by chronic suppression with oral doxycycline. Despite its low virulence, a growing number of C. acnes PVE cases have been reported, owing to its biofilm production. When clinical suspicion is high, extending culture incubation duration beyond the standard 5 days might be helpful. Most cases are treated with surgical repair or replacement in conjunction with antibiotics, but medical therapy alone has been documented as being successful.
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Affiliation(s)
| | - Takaaki Kobayashi
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Joseph Tholany
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Poorani Sekar
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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6
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Brüggemann H, Salar-Vidal L, Gollnick HPM, Lood R. A Janus-Faced Bacterium: Host-Beneficial and -Detrimental Roles of Cutibacterium acnes. Front Microbiol 2021; 12:673845. [PMID: 34135880 PMCID: PMC8200545 DOI: 10.3389/fmicb.2021.673845] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/29/2021] [Indexed: 12/18/2022] Open
Abstract
The bacterial species Cutibacterium acnes (formerly known as Propionibacterium acnes) is tightly associated with humans. It is the dominant bacterium in sebaceous regions of the human skin, where it preferentially colonizes the pilosebaceous unit. Multiple strains of C. acnes that belong to phylogenetically distinct types can co-exist. In this review we summarize and discuss the current knowledge of C. acnes regarding bacterial properties and traits that allow host colonization and play major roles in host-bacterium interactions and also regarding the host responses that C. acnes can trigger. These responses can have beneficial or detrimental consequences for the host. In the first part of the review, we highlight and critically review disease associations of C. acnes, in particular acne vulgaris, implant-associated infections and native infections. Here, we also analyse the current evidence for a direct or indirect role of a C. acnes-related dysbiosis in disease development or progression, i.e., reduced C. acnes strain diversity and/or the predominance of a certain phylotype. In the second part of the review, we highlight historical and recent findings demonstrating beneficial aspects of colonization by C. acnes such as colonization resistance, immune system interactions, and oxidant protection, and discuss the molecular mechanisms behind these effects. This new insight led to efforts in skin microbiota manipulation, such as the use of C. acnes strains as probiotic options to treat skin disorders.
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Affiliation(s)
| | - Llanos Salar-Vidal
- Department of Clinical Microbiology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Harald P. M. Gollnick
- Department of Dermatology and Venerology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Rolf Lood
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
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7
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Lim HJ, Kang SH, Song YJ, Jeon YD, Jin JS. Inhibitory Effect of Quercetin on Propionibacterium acnes-induced Skin Inflammation. Int Immunopharmacol 2021; 96:107557. [PMID: 33812252 DOI: 10.1016/j.intimp.2021.107557] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
Quercetin is a well-known antioxidant and a plant polyphenolic of flavonoid group found in many fruits, leaves, and vegetables. Propionibacterium acnes is a key skin pathogen involved in the progression of acne inflammation. Although quercetin has been applied to treat various inflammatory diseases, the effects of quercetin on P. acnes-induced skin inflammation have not been explored. This study investigated the effects of quercetin on P. acnes-induced inflammatory skin disease in vitro and in vivo. The results showed that quercetin suppressed the production of pro-inflammatory cytokines in P. acnes-stimulated HaCaT, THP-1 and RAW 264.7 cells. Additionally, quercetin reduced the production of TLR-2 and the phosphorylation of p38, ERK and JNK MAPKs in P. acnes-stimulated HaCaT and THP-1 cells. It also suppressed MMP-9 mRNA levels in two cell lines exposed to P. acnes in vitro. In the case of in vivo, P. acnes was intradermally injected into the ears of mice and it resulted in cutaneous erythema, swelling, and a granulomatous response. Treatment with quercetin markedly reduced ear thickness and swelling. These results suggested that quercetin can be a potential therapeutic agent against P. acnes-induced skin inflammation and may have diverse pharmaceutical and cosmetics applications.
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Affiliation(s)
- Hyeon-Ji Lim
- Jeonju AgroBio-Materials Institute, 111-27, Wonjangdong-gill, Jeonju, Jeollabuk-do 54810, Republic of Korea; Department of Oriental Medicine Resources, Jeonbuk National University, 79 Gobong-ro, Iksan, Jeollabuk-do 54596, Republic of Korea
| | - Sa-Haeng Kang
- Department of Oriental Medicine Resources, Jeonbuk National University, 79 Gobong-ro, Iksan, Jeollabuk-do 54596, Republic of Korea
| | - Young-Jae Song
- Department of Oriental Medicine Resources, Jeonbuk National University, 79 Gobong-ro, Iksan, Jeollabuk-do 54596, Republic of Korea
| | - Yong-Deok Jeon
- Department of Korean Pharmacy, College of Pharmacy, Woosuk University, 443 Samrye-ro, Samrye-eup, Wanju-gun, Jeollabuk-do 55338, Republic of Korea
| | - Jong-Sik Jin
- Department of Oriental Medicine Resources, Jeonbuk National University, 79 Gobong-ro, Iksan, Jeollabuk-do 54596, Republic of Korea.
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8
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Shiban E, Joerger AK, Janssen I, Issa M, Lange N, Wagner A, Feihl S, Ringel F, Meyer B. Low-Grade Infection and Implant Failure Following Spinal Instrumentation: A Prospective Comparative Study. Neurosurgery 2021; 87:964-970. [PMID: 32409827 DOI: 10.1093/neuros/nyaa133] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spinal instrumentation can be associated with complications, including implant loosening. Hitherto, implant loosening has mainly been attributed to mechanical overload. OBJECTIVE To examine the role of low-grade infections as the cause of implant failure in suspected aseptic implant loosening following spinal instrumentation. METHODS A prospective single center observational study was performed. All patients who had revision surgery following spinal instrumentation between August 2015 and February 2018 were screened. Patients with revision surgery due to screw loosening on the computed tomograhy scan constituted the study group. Patients in which the screws where not loosened but removal was performed for other reasons formed the comparison group. Intraoperative swabs were taken and sonication was performed with the explanted material. Results of microbiological cultivation were analyzed. RESULTS A total of 59 patients were included in the study group and 34 in the comparison group. In the study group in 42.4% of the cultures a bacterium was detected, while in the comparison group only in 17.6%. 84%, and 83.3% of these germs were detected by sonication in the study and comparison group, respectively. The rate of positive cultures was significantly higher in the study group compared to the comparison group (P = .001). The most frequent bacterium cultivated in both groups was Propionibacterium acnes, followed by Staphylococcus species. CONCLUSION For patients with screw loosening a high level of suspicion for a low-grade infection should be raised. Cultures should be performed from the sonication fluid of the explanted devices in all patients with symptomatic screw loosening.
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Affiliation(s)
- Ehab Shiban
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany.,Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Ann-Kathrin Joerger
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Insa Janssen
- Department of Neurosurgery, Hopitaux Universitaires Genève, Switzerland
| | - Mohammed Issa
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Nicole Lange
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Susanne Feihl
- Department of Microbiology, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Universitätsklinikum Mainz, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University, Munich, Germany
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9
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Evaluation of Optimal Blood Culture Incubation Time To Maximize Clinically Relevant Results from a Contemporary Blood Culture Instrument and Media System. J Clin Microbiol 2021; 59:JCM.02459-20. [PMID: 33239377 PMCID: PMC8106720 DOI: 10.1128/jcm.02459-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022] Open
Abstract
Timely diagnosis of microorganisms in blood cultures is necessary to optimize therapy. Although blood culture media and systems have evolved for decades, the standard interval for incubation prior to being discarded as negative has remained 5 days. Here, we evaluated the optimal incubation time for the BacT/Alert Virtuo blood culture detection system (bioMérieux) using FA Plus (aerobic) and FN Plus (anaerobic) resin culture bottles in routine clinical use. Timely diagnosis of microorganisms in blood cultures is necessary to optimize therapy. Although blood culture media and systems have evolved for decades, the standard interval for incubation prior to being discarded as negative has remained 5 days. Here, we evaluated the optimal incubation time for the BacT/Alert Virtuo blood culture detection system (bioMérieux) using FA Plus (aerobic) and FN Plus (anaerobic) resin culture bottles in routine clinical use. Following institutional review board (IRB) approval, a retrospective review evaluated the outcomes of 158,710 bottles collected between November 2018 and October 2019. The number of positive blood bottles was 13,592 (8.6%); 99% of positive aerobic and anaerobic bottles flagged positive by 91.5 and 108 h, respectively. The mean (median) times to positivity were 18.4 h (15.6 h) for Staphylococcus aureus, 12.3 h (9.5 h) for Escherichia coli, 22.2 h (15.9 h) for Pseudomonas aeruginosa, and 48.9 h (42.9 h) for Candida spp. Only 175 bottles (0.1% of all bottles) flagged positive after 4 days of incubation; 89 (51%) of these bottles grew Cutibacterium (Propionibacterium) species. Chart review of blood cultures positive after 4 days (96 h) rarely had a clinical impact and sometimes had a negative impact on patient care. Finally, a seeded study of the HACEK group (i.e., Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella), historically associated with delayed blood culture positivity, demonstrated no benefit to extended incubation beyond 4 days. Collectively, these findings demonstrated that a 4-day incubation time was sufficient for the Virtuo system and media. Implementation of the 4-day incubation time could enhance clinically relevant results by reducing recovery of contaminants and finalizing blood cultures 1 day earlier.
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10
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Kotova EO, Domonova EA, Kobalava ZD, Shipulina OY, Karaulova YL, Pisaryuk AS. [Infective Endocarditis with Unknown Etiology: Possibilities of Conquering and Role of Microbiologistics]. ACTA ACUST UNITED AC 2021; 61:87-97. [PMID: 33706691 DOI: 10.18087/cardio.2021.1.n1218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022]
Abstract
Current infectious endocarditis (IE) is characterized by changes in its etiological and epidemiological profiles associated with increased incidence of IE of undetermined etiology. This requires a search for ways to enhance the effectivity of diagnosis. Microbiologistics along with high-tech methods becomes decisively important for identifying the pathogen by studying cultures of blood and tissues from the affected heart valve. This determines timely diagnosis and treatment to be introduced to medical practice as a component of personalized medicine. The article focuses on the validity and features of microbiological (cultural), immunochemical, and molecular biological [MALDI-TOF MS (matrix-activated laser desorption/ionization with time-of-flight mass spectrometry), polymerase chain reaction, sequencing] studies.
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Affiliation(s)
- E O Kotova
- Peoples' Friendship University of Russia (RUDN), Moscow
| | - E A Domonova
- Central Research Institute of Epidemiology" of The Federal Service on Customers' Rights Protection and Human Wellbeing Surveillance, Moscow
| | - Zh D Kobalava
- Peoples' Friendship University of Russia (RUDN), Moscow
| | - O Y Shipulina
- Central Research Institute of Epidemiology" of The Federal Service on Customers' Rights Protection and Human Wellbeing Surveillance, Moscow
| | - Y L Karaulova
- Peoples' Friendship University of Russia (RUDN), Moscow
| | - A S Pisaryuk
- Peoples' Friendship University of Russia (RUDN), Moscow; City Hospital named after V.V. Vinogradov, Moscow
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11
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Talha KM, DeSimone DC, Sohail MR, Baddour LM. Pathogen influence on epidemiology, diagnostic evaluation and management of infective endocarditis. Heart 2020; 106:1878-1882. [PMID: 32847941 DOI: 10.1136/heartjnl-2020-317034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
Infective endocarditis (IE) is uncommon and has, in the past, been most often caused by viridans group streptococci (VGS). Due to the indolent nature of these organisms, the phrase 'subacute bacterial endocarditis', so-called 'SBE', was routinely used as it characterised the clinical course of most patients that extended for weeks to months. However, in more recent years, there has been a significant shift in the microbiology of IE with the emergence of staphylococci as the most frequent pathogens, and for IE due to Staphylococcus aureus, the clinical course is acute and can be associated with sepsis. Moreover, increases in IE due to enterococci have occurred and have been characterised by treatment-related complications and worse outcomes. These changes in pathogen distribution have been attributed to a diversification in the target population at risk of IE. While prosthetic valve endocarditis and history of IE remain at highest risk of IE, the rise in prevalence of injection drug use, intracardiac device implantations and other healthcare exposures have heavily contributed to the existing pool of at-risk patients. This review focuses on common IE pathogens and their impact on the clinical profile of IE.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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12
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Persistent Cutibacterium (Formerly Propionibacterium) acnes Bacteremia and Refractory Endocarditis in a Patient with Retained Implantable Pacemaker Leads. Case Rep Infect Dis 2020; 2020:8883907. [PMID: 32774952 PMCID: PMC7399732 DOI: 10.1155/2020/8883907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/16/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022] Open
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.
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13
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Lodhi SH, Abbasi A, Ahmed T, Chan A. Acne on the Valve: Two Intriguing Cases of Cutibacterium Acnes Endocarditis. Cureus 2020; 12:e8532. [PMID: 32665879 PMCID: PMC7352884 DOI: 10.7759/cureus.8532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/09/2020] [Indexed: 01/28/2023] Open
Abstract
Cutibacterium acnes is a skin commensal which is most often regarded as a contaminant when detected on blood cultures. In rare instances, it may be the causative pathogen in severe systemic illnesses. Subacute endocarditis, especially of prosthetic valves and devices, is an important grave pathology caused by Cutibacterium acnes. Herein we report two cases of prosthetic valve endocarditis with varied presentations as valve dehiscence with a "rocking" prosthetic valve apparatus in one encounter and as a septic embolic stroke in the second encounter. Although a rare cause of endocarditis, it becomes an especially important entity in patients with prosthetic devices and should be high in the list of differentials.
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Affiliation(s)
- Samra Haroon Lodhi
- Internal Medicine, King Edward Medical University, Lahore, PAK
- Internal Medicine, Mayo Hospital, Lahore, PAK
| | - Ayesha Abbasi
- Internal Medicine, King Edward Medical University, Lahore, PAK
- Internal Medicine, Mayo Hospital, Lahore, PAK
| | - Taha Ahmed
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Albert Chan
- Cardiovascular Medicine, Cleveland Clinic Fairview Hospital, Cleveland, USA
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14
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Rosa davurica Pall. Improves Propionibacterium acnes-Induced Inflammatory Responses in Mouse Ear Edema Model and Suppresses Pro-Inflammatory Chemokine Production via MAPK and NF-κB Pathways in HaCaT Cells. Int J Mol Sci 2020; 21:ijms21051717. [PMID: 32138302 PMCID: PMC7084861 DOI: 10.3390/ijms21051717] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 11/17/2022] Open
Abstract
Acne, also known as acne vulgaris, is a common disorder of human skin involving the sebaceous gland and Propionibacterium acnes (P. acnes). Although there are a number of treatments suggested for acne, many of them have limitations in their safety and have efficacy issues. Therefore, there is a high demand to develop safe and effective novel acne treatments. In the present study, we demonstrate the protective effects of Rosa davurica Pall. leaves (RDL) extract against P. acnes-induced inflammatory responses in vitro and in vivo. The results showed that RDL dose-dependently inhibited the growth of skin bacteria, including P. acnes (KCTC3314) and aerobic Staphylococcus aureus (KCTC1621) or Staphylococcus epidermidis (KCTC1917). The downregulation of proinflammatory cytokines by RDL appears to be mediated by blocking the phosphorylations of mitogen-activated protein kinase (MAPK) and subsequent nuclear factor-kappa B (NF-κB) pathways in P. acnes-stimulated HaCaT cells. In a mouse model of acne vulgaris, histopathological changes were examined in the P. acnes-induced mouse ear edema. The concomitant intradermal injection of RDL resulted in the reduction of ear swelling in mice along with microabscess but exerted no cytotoxic effects for skin cells. Instrumental analysis demonstrated there were seven major components in the RDL extract, and they seemed to have important roles in the anti-inflammatory and antimicrobial effects of RDL. Conclusively, our present work showed for the first time that RDL has anti-inflammatory and antimicrobial effects against P. acnes, suggesting RDL as a promising novel strategy for the treatment of acne, including natural additives in anti-acne cosmetics or pharmaceutical products.
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Legaria MC, Barberis C, Camporro J, Traglia GM, Famiglietti A, Stecher D, Vay CA. Intra-peritoneal abscess after an abdominal hysterectomy involving Cutibacterium avidum (former Propionibacterium avidum) highly resistant to clindamycin. Anaerobe 2019; 59:176-183. [PMID: 31254654 DOI: 10.1016/j.anaerobe.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
Cutibacterium avidum is a gram-positive anaerobic rod belonging to the cutaneous group of human bacteria with preferential colonization of sweat glands in moist areas. The microorganism rarely cause disease, generally delayed prosthetic joint infections (PJIs). We describe the second case of intraperitoneal abscess by C. avidum after an abdominal surgery in an obese female patient and the first case after a non-prosthetic abdominal surgery due to a highly clindamycin resistant strain in a patient with underling conditions. The patient was successfully treated with surgical drainage and beta-lactam antibiotics. Although rare and apparently non-pathogenic, C. avidum may be involved in infections, especially in some high-risk patients with obesity who have undergone surgical incision involving deep folder of the skin. The microorganism was identified by phenotypic methods, MALDI-TOF MS and 16S rRNA gene sequencing. Susceptibility test should be performed in C. avidum because high level resistance to clindamycin could be present. We present a literature review of C. avidum infections.
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Affiliation(s)
- M C Legaria
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Buenos Aires, Argentina.
| | - C Barberis
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Buenos Aires, Argentina
| | - J Camporro
- Universidad de Buenos Aires. Facultad de Medicina, Hospital de Clínicas José de San Martín, Servicio de Infectología, Buenos Aires, Argentina
| | - G M Traglia
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Buenos Aires, Argentina
| | - A Famiglietti
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Buenos Aires, Argentina
| | - D Stecher
- Universidad de Buenos Aires. Facultad de Medicina, Hospital de Clínicas José de San Martín, Servicio de Infectología, Buenos Aires, Argentina
| | - C A Vay
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Buenos Aires, Argentina
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Propionibacterium acnes Pacemaker Endocarditis in a Patient With a Redundant Loop of the Ventricular Lead. Clin Nucl Med 2019; 45:e55-e56. [DOI: 10.1097/rlu.0000000000002686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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[Febrile myalgia revealing Propionibacterium acnes endocarditis]. Rev Med Interne 2019; 40:613-616. [PMID: 31229357 DOI: 10.1016/j.revmed.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Propionibacterium acnes endocarditis is rare and difficult to diagnose. We report a case of Propioniacterium acnes endocarditis revealed by a lower limb fasciitis. CASE REPORT A 54-year-old patient presented with recurrent febrile myalgia of the lower limbs, that appeared three years after an aortic surgery (aortic valve sparing reimplentation and ascending aortic prosthesis implantation). Computer tomography showed fasciitis of both legs. Positron emission tomography showed 18Fluorodeoxyglucose intake of the aortic prosthesis and in muscles of the lower limbs. Ten days after blood sample drawing, cultures showed the presence of Propionibacterium acnes. The aortic prosthesis was surgically removed, whose culture confirmed infection by Propionibacterium acnes. The diagnosis of infective endocarditis revealed by lower limb emboli was made. Evolution was favorable. CONCLUSION In patients with vascular prostheses, Propionibacterium acnes infection must be evoked face to an atypical inflammatory process. Very prolonged blood culture incubation is needed to identify the pathogen.
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Claesen J. Topical Antiseptics and the Skin Microbiota. J Invest Dermatol 2019; 138:2106-2107. [PMID: 30244719 DOI: 10.1016/j.jid.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/30/2022]
Abstract
The impact of antiseptics on the skin microbiota is poorly understood. SanMiguel et al. (2018) use a sequencing-based approach to compare treatment effects and find that they are dependent on interpersonal and body site-specific community differences. While treatment results in an immediate depletion of the skin microbiota, not all bacterial families are affected equally.
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Affiliation(s)
- Jan Claesen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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19
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Peker N, Garcia-Croes S, Dijkhuizen B, Wiersma HH, van Zanten E, Wisselink G, Friedrich AW, Kooistra-Smid M, Sinha B, Rossen JWA, Couto N. A Comparison of Three Different Bioinformatics Analyses of the 16S-23S rRNA Encoding Region for Bacterial Identification. Front Microbiol 2019; 10:620. [PMID: 31040829 PMCID: PMC6476902 DOI: 10.3389/fmicb.2019.00620] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/12/2019] [Indexed: 11/25/2022] Open
Abstract
Rapid and reliable identification of bacterial pathogens directly from patient samples is required for optimizing antimicrobial therapy. Although Sanger sequencing of the 16S ribosomal RNA (rRNA) gene is used as a molecular method, species identification and discrimination is not always achievable for bacteria as their 16S rRNA genes have sometimes high sequence homology. Recently, next generation sequencing (NGS) of the 16S–23S rRNA encoding region has been proposed for reliable identification of pathogens directly from patient samples. However, data analysis is laborious and time-consuming and a database for the complete 16S–23S rRNA encoding region is not available. Therefore, a better, faster, and stronger approach is needed for NGS data analysis of the 16S–23S rRNA encoding region. We compared speed and diagnostic accuracy of different data analysis approaches: de novo assembly followed by Basic Local Alignment Search Tool (BLAST), operational taxonomic unit (OTU) clustering, or mapping using an in-house developed 16S–23S rRNA encoding region database for the identification of bacterial species. De novo assembly followed by BLAST using the in-house database was superior to the other methods, resulting in the shortest turnaround time (2 h and 5 min), approximately 2 h less than OTU clustering and 4.5 h less than mapping, and a sensitivity of 80%. Mapping was the slowest and most laborious data analysis approach with a sensitivity of 60%, whereas OTU clustering was the least laborious approach with 70% sensitivity. Although the in-house database requires more sequence entries to improve the sensitivity, the combination of de novo assembly and BLAST currently appears to be the optimal approach for data analysis.
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Affiliation(s)
- Nilay Peker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sharron Garcia-Croes
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Brigitte Dijkhuizen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Henry H Wiersma
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Evert van Zanten
- Department of Medical Microbiology, Certe, Groningen, Netherlands
| | - Guido Wisselink
- Department of Medical Microbiology, Certe, Groningen, Netherlands
| | - Alex W Friedrich
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mirjam Kooistra-Smid
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Medical Microbiology, Certe, Groningen, Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - John W A Rossen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Natacha Couto
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Jersie-Christensen RR, Lanigan LT, Lyon D, Mackie M, Belstrøm D, Kelstrup CD, Fotakis AK, Willerslev E, Lynnerup N, Jensen LJ, Cappellini E, Olsen JV. Quantitative metaproteomics of medieval dental calculus reveals individual oral health status. Nat Commun 2018; 9:4744. [PMID: 30459334 PMCID: PMC6246597 DOI: 10.1038/s41467-018-07148-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/09/2018] [Indexed: 12/16/2022] Open
Abstract
The composition of ancient oral microbiomes has recently become accessible owing to advanced biomolecular methods such as metagenomics and metaproteomics, but the utility of metaproteomics for such analyses is less explored. Here, we use quantitative metaproteomics to characterize the dental calculus associated with the remains of 21 humans retrieved during the archeological excavation of the medieval (ca. 1100-1450 CE) cemetery of Tjærby, Denmark. We identify 3671 protein groups, covering 220 bacterial species and 81 genera across all medieval samples. The metaproteome profiles of bacterial and human proteins suggest two distinct groups of archeological remains corresponding to health-predisposed and oral disease-susceptible individuals, which is supported by comparison to the calculus metaproteomes of healthy living individuals. Notably, the groupings identified by metaproteomics are not apparent from the bioarchaeological analysis, illustrating that quantitative metaproteomics has the potential to provide additional levels of molecular information about the oral health status of individuals from archeological contexts.
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Affiliation(s)
- Rosa R Jersie-Christensen
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Liam T Lanigan
- Natural History Museum of Denmark, University of Copenhagen, Øster Voldgade 5-7, 1350, Copenhagen K, Denmark
| | - David Lyon
- Disease Systems Biology Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Meaghan Mackie
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
- Natural History Museum of Denmark, University of Copenhagen, Øster Voldgade 5-7, 1350, Copenhagen K, Denmark
| | - Daniel Belstrøm
- Periodontology and Microbiology, Department of Odontology, Faculty of Health Sciences, University of Copenhagen, Nørre Allé 20, 2200, Copenhagen N, Denmark
| | - Christian D Kelstrup
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Anna K Fotakis
- Natural History Museum of Denmark, University of Copenhagen, Øster Voldgade 5-7, 1350, Copenhagen K, Denmark
| | - Eske Willerslev
- Centre for GeoGenetics, Natural History Museum of Denmark, University of Copenhagen, Øster Voldgade 5-7, 1350, Copenhagen K, Denmark
- Department of Zoology, University of Cambridge, Downing St, Cambridge, CB2 3EJ, UK
| | - Niels Lynnerup
- Laboratory of Biological Anthropology, Institute of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Frederik V's Vej 11, 2100, Copenhagen Ø, Denmark
| | - Lars J Jensen
- Disease Systems Biology Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Enrico Cappellini
- Natural History Museum of Denmark, University of Copenhagen, Øster Voldgade 5-7, 1350, Copenhagen K, Denmark.
| | - Jesper V Olsen
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
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Fida M, Dylla BL, Sohail MR, Pritt BS, Schuetz AN, Patel R. Role of prolonged blood culture incubation in infective endocarditis diagnosis. Eur J Clin Microbiol Infect Dis 2018; 38:197-198. [DOI: 10.1007/s10096-018-3397-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
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22
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Native Valve Propionibacterium acnes Endocarditis From Self-injection of Vitamins. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Yamamoto R, Miyagawa S, Hagiya H, Kimura K, Nishi I, Yamamoto N, Yoshida H, Akeda Y, Tomono K, Toda K, Sawa Y. Silent Native-valve Endocarditis Caused by Propionibacterium acnes. Intern Med 2018; 57:2417-2420. [PMID: 29607974 PMCID: PMC6148182 DOI: 10.2169/internalmedicine.9833-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We describe a rare case of Propionibacterium acnes native-valve endocarditis that silently progressed in a 67-year-old man with hybrid dialysis. The patient was scheduled for kidney transplantation, and pre-operative investigation incidentally detected a vegetative structure at his native mitral valve that had increased in size. He underwent cardiac surgery and P. acnes was detected in cultures of a resected cardiac valve specimen and blood. This case highlights that P. acnes can silently cause infective endocarditis in a native-valve, and that physicians should consider the possibility of infection when P. acnes is isolated in blood cultures.
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Affiliation(s)
- Rintaro Yamamoto
- Department of Cardiovascular Surgery, Osaka University Hospital, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Hospital, Japan
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Isao Nishi
- Laboratory for Clinical Investigation, Osaka University Hospital, Japan
| | - Norihisa Yamamoto
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Yukihiro Akeda
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Hospital, Japan
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Corvec S. Clinical and Biological Features of Cutibacterium (Formerly Propionibacterium) avidum, an Underrecognized Microorganism. Clin Microbiol Rev 2018; 31:e00064-17. [PMID: 29848774 PMCID: PMC6056840 DOI: 10.1128/cmr.00064-17] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The recent description of the genus Cutibacterium has altered the taxonomy of Propionibacterium species. These organisms still belong to the genera of the skin coryneform group, and the most-studied species remains Cutibacterium acnes. Cutibacterium avidum is also a known skin commensal. This underrecognized microorganism can, however, act as a pathogen after bacterial seeding and can be considered opportunistic, causing either superficial or deep/invasive infections. It can cause numerous infections, including but not limited to breast infections, skin abscesses, infective endocarditis, and device-related infections. The ecological niche of C. avidum is clearly different from that of other members of the genus: it is found in the axillary region or at wet sites rather than in dry, exposed areas, and the number of microorganisms increases during puberty. Historically, it has been used for its ability to modulate the immune response and for its antitumor properties. Conventional microbial culture methods and identification processes allow for its accurate identification and characterization. Thanks to the modern omics tools used for phylogenomic approaches, understanding C. avidum pathogenesis (including host-bacterium interactions and virulence factor characterization) is becoming easier, allowing for more thorough molecular characterization. These analyses have revealed that C. avidum causes diverse diseases mediated by multiple virulence factors. The recent genome approach has revealed specific genomic regions within this species that are involved in adherence and biofilm formation as well as fitness, survival, and defense functions. Numerous regions show the presence of phages and horizontal gene transfer. C. avidum remains highly sensitive to a broad spectrum of antibiotics, such as β-lactams, fluoroquinolones, macrolides, and rifampin, although erythromycin and clindamycin resistance has been described. A long-term treatment regimen with a combination of antibiotics is required to successfully eliminate the remaining adherent bacteria, particularly in the case of deep infections after debridement surgery.
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Affiliation(s)
- Stéphane Corvec
- CHU Nantes, Service de Bactériologie-Hygiène Hospitalière, Nantes, France
- CRCINA, INSERM, U1232, Université de Nantes, Nantes, France
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Verkaik N, Schurink C, Melles D. Antibiotic treatment of Propionibacterium acnes endocarditis. Clin Microbiol Infect 2018; 24:209. [DOI: 10.1016/j.cmi.2017.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
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Prosthetic valve endocarditis caused by Propionibacterium species: a national registry-based study of 51 Swedish cases. Eur J Clin Microbiol Infect Dis 2018; 37:765-771. [PMID: 29380224 PMCID: PMC5978902 DOI: 10.1007/s10096-017-3172-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/19/2017] [Indexed: 01/27/2023]
Abstract
Propionibacterium spp. are a rare cause of infective endocarditis (IE). The diagnosis is difficult because the bacteria are slow-growing and growth in blood cultures is often misinterpreted as contamination from the skin flora. The aim of this study was to describe all cases of Propionibacterium spp. endocarditis in the Swedish national registry of IE. The registry was searched for all cases of IE from 1995 to 2016 caused by Propionibacterium spp. Data concerning clinical characteristics, treatment, and outcome were registered. A total of 51 episodes of definitive prosthetic valve endocarditis (PVE) caused by Propionibacterium spp. were identified, comprising 8% of cases of PVE during the study period. Almost all cases (n = 50) were male. The median time from surgery to diagnosis of IE was 3 years. Most patients were treated mainly with beta-lactams, partly in combination with aminoglycosides. Benzyl-penicillin was the most frequently used beta-lactam. A total of 32 patients (63%) underwent surgery. Overall, 47 patients (92.1%) were cured, 3 (5.9%) suffered relapse, and 1 (2.0%) died during treatment. IE caused by Propionibacterium spp. almost exclusively affects men with a prosthetic valve and findings of Propionibacterium spp. in blood cultures in such patients favors suspicion of a possible diagnosis of IE. In patients with prosthetic valves, prolonged incubation of blood cultures up to 14 days is recommended. The prognosis was favorable, although a majority of patients required cardiac surgery during treatment. Benzyl-penicillin should be the first-line antibiotic treatment option for IE caused by Propionibacterium spp.
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Garric M, Moulis G, Boumaza X, Paricaud K, Astudillo L, Porte L, Lansalot-Matras P, Bos F, Pugnet G, Sailler L. Endocardite infectieuse à Propionibacterium acnes révélée par des myalgies. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Computed tomography fistulography of the sternum. A case report on interprofessional collaboration between radiologist and surgeon. Int J Surg Case Rep 2017; 41:97-98. [PMID: 29055879 PMCID: PMC5651541 DOI: 10.1016/j.ijscr.2017.08.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Trans sternal fistula can occur after sternotomy/heart surgery. Diagnosing this can be difficult. PRESENTATION OF CASE In this report, we present a unique case of a patient with infection of an ascending aortic prosthetic graft. This patient was oozing from the wound despite several revisions. Many fistulographies were performed before fistulography with surgeon and radiologist revealed a trans sternal fistula. DISCUSSION Infection with Propionibacterium acnes is often difficult to diagnose. This is in line with the present case, where a surgeon guided fistulography had to be performed followed by appropriate redo surgery with succesful subsequent sternal wound healing. CONCLUSION Our case demonstrates the importance of performing a fistulography with the presence of a surgeon, to obtain the best possible result.
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Abstract
Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis.
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Banzon J, Rehm S, Gordon S, Hussain S, Pettersson G, Shrestha N. Propionibacterium acnes endocarditis: a case series. Clin Microbiol Infect 2017; 23:396-399. [DOI: 10.1016/j.cmi.2016.12.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/16/2016] [Accepted: 12/25/2016] [Indexed: 01/12/2023]
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Olmos C, Vilacosta I, López J, Sarriá C, Ferrera C, San Román JA. Actualización en endocarditis protésica. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Loureiro-Amigo J, Pons S, Sierra M, Meije Y. Prosthetic valve with infective endocarditis caused by Propionibacterium avidum. A case report. Enferm Infecc Microbiol Clin 2016; 35:196-197. [PMID: 27743680 DOI: 10.1016/j.eimc.2016.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Jose Loureiro-Amigo
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Silvia Pons
- Cardiology Unit, Hospital de Barcelona, SCIAS, Barcelona, Spain
| | - Montserrat Sierra
- Microbiology Department, Hospital de Barcelona, SCIAS, Barcelona, Spain
| | - Yolanda Meije
- Infectious Disease Unit - Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain.
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Herren T, Middendorp MA, Zbinden R. Quantification of the antibody response to Propionibacterium acnes in a patient with prosthetic valve endocarditis: - a case report. BMC Infect Dis 2016; 16:185. [PMID: 27126586 PMCID: PMC4850718 DOI: 10.1186/s12879-016-1522-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 04/20/2016] [Indexed: 11/16/2022] Open
Abstract
Background The 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 presentation We 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. Conclusion The 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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Affiliation(s)
- T Herren
- Department of Medicine, Limmattal Hospital, Urdorferstrasse 100, CH-8952, Schlieren, Switzerland.
| | - M A Middendorp
- Department of Surgery, Kantonsspital, Im Ergel 1, CH-5404, Baden, Switzerland
| | - R Zbinden
- Microbiological Laboratory, Limmattal Hospital, Urdorferstrasse 100, CH-8952, Schlieren, Switzerland
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El Rafei A, Desimone DC, Sohail MR, Desimone CV, Steckelberg JM, Wilson WR, Baddour LM. Cardiovascular Implantable Electronic Device Infections due to Propionibacterium Species. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:522-30. [PMID: 26970081 DOI: 10.1111/pace.12845] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/04/2016] [Accepted: 03/06/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Propionibacterium species are part of the normal skin flora and often considered contaminants when identified in cultures. However, they can cause life-threatening infections, including prosthetic cardiovascular device infections. Clinical presentation and management of cardiovascular implantable electronic device (CIED) infection due to Propionibacterium species has not been well described. METHODS Retrospective review of all cases of CIED infection due to Propionibacterium species admitted to Mayo Clinic between January 1, 1990 and December 31, 2014. Patient charts were reviewed for clinical, microbiological, and imaging data. Descriptive analysis was performed. RESULTS We identified 14 patients with CIED infection due to Propionibacterium species, accounting for 2.3% of all CIED infections. Patients were predominantly male (n = 12, 86%). The median age at admission was 58.5 years (range 22-83). Twelve patients had implantable cardioverter defibrillators (ICDs) and two had permanent pacemaker systems. Twelve patients had generator pocket infection (86%). Two patients met clinical criteria for CIED-related infective endocarditis. Median time between last device manipulation and infection was 9 months (range 1-98). All patients were treated with complete device removal and antibiotic therapy. Six-month follow-up data were available for 10 patients (71%), with no relapses documented. CONCLUSION CIED infections due to Propionibacterium species accounted for 2.3% of all device infections over a 25-year period. The most common infectious syndrome was generator pocket infection with delayed onset. There was an unanticipated predominance of ICDs in this cohort. Cure was achieved in all cases with complete device removal and antibiotic therapy.
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Affiliation(s)
- Abdelghani El Rafei
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Daniel C Desimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Christopher V Desimone
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - James M Steckelberg
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Walter R Wilson
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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van Valen R, de Lind van Wijngaarden RAF, Verkaik NJ, Mokhles MM, Bogers AJJC. Prosthetic valve endocarditis due to Propionibacterium acnes. Interact Cardiovasc Thorac Surg 2016; 23:150-5. [PMID: 27052748 DOI: 10.1093/icvts/ivw087] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/04/2016] [Indexed: 01/26/2023] Open
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.
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Affiliation(s)
- Richard van Valen
- Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands
| | | | - Nelianne J Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Mostafa M Mokhles
- Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands
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Rienmüller A, Borens O. Propionibacterium prosthetic joint infection: experience from a retrospective database analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:429-34. [PMID: 27017334 PMCID: PMC4856714 DOI: 10.1007/s00590-016-1766-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND With improved diagnostic methods and longer prosthesis indwelling time, the frequency of diagnosed Propionibacterium prosthetic joint infections (PJI) is increasing. Data on clinical, microbiological, radiological and surgical treatment are limited, and importance of this organism in PJI is probably underestimated. MATERIALS AND METHODS We retrospectively analyzed patients with PJI caused by Propionibacterium spp. diagnosed at our institution between 2000 and 2012. Patient data were retrieved through chart review, and the outcome was evaluated at patient follow-up visits. RESULTS Of 15 included patients (median age 65 years, range 44-87), 8 hip, 4 shoulder, 2 knee and 1 ankle PJI were recorded. The median time from implantation to diagnosis of PJI was 44.2 months (range 2-180 months). Most PJI (8 patients, 53 %) were diagnosed late (>24 months after arthroplasty). Persistent pain was present in 13, local joint symptoms in 8, fever in 4 and sinus tract in 3 patients. Radiological signs of loosening were present in 11 patients (73 %). Organisms were detected in intraoperative biopsy (n = 5), sonication (n = 4) or preoperative joint puncture (n = 4). In three cases coinfection with a coagulase-negative staphylococcus was diagnosed. Revision surgery was performed in all cases. After a mean follow-up of 16 months after revision surgery (range 4-37 months), 14 patients (93 %) showed no signs or symptoms of infection and had a functional prosthesis; one patient experienced a new infection with another organism (Staphylococcus epidermidis). CONCLUSION Patients with persistent postoperative pain and/or loosening of implants should be screened for PJI with low-virulent organisms such as Propionibacterium, including.
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Affiliation(s)
- Anna Rienmüller
- Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland. .,Department of Orthopedic Surgery, Vienna General Hospital, Medical University Vienna, Waehriger Guertel 18-20, 1090, Vienna, Austria.
| | - Olivier Borens
- Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
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Propionibacterium acnes: Disease-Causing Agent or Common Contaminant? Detection in Diverse Patient Samples by Next-Generation Sequencing. J Clin Microbiol 2016; 54:980-7. [PMID: 26818667 PMCID: PMC4809928 DOI: 10.1128/jcm.02723-15] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/16/2016] [Indexed: 01/01/2023] Open
Abstract
Propionibacterium acnes is the most abundant bacterium on human skin, particularly in sebaceous areas. P. acnes is suggested to be an opportunistic pathogen involved in the development of diverse medical conditions but is also a proven contaminant of human clinical samples and surgical wounds. Its significance as a pathogen is consequently a matter of debate. In the present study, we investigated the presence of P. acnes DNA in 250 next-generation sequencing data sets generated from 180 samples of 20 different sample types, mostly of cancerous origin. The samples were subjected to either microbial enrichment, involving nuclease treatment to reduce the amount of host nucleic acids, or shotgun sequencing. We detected high proportions of P. acnes DNA in enriched samples, particularly skin tissue-derived and other tissue samples, with the levels being higher in enriched samples than in shotgun-sequenced samples. P. acnes reads were detected in most samples analyzed, though the proportions in most shotgun-sequenced samples were low. Our results show that P. acnes can be detected in practically all sample types when molecular methods, such as next-generation sequencing, are employed. The possibility of contamination from the patient or other sources, including laboratory reagents or environment, should therefore always be considered carefully when P. acnes is detected in clinical samples. We advocate that detection of P. acnes always be accompanied by experiments validating the association between this bacterium and any clinical condition.
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Sivasankar C, Maruthupandiyan S, Balamurugan K, James PB, Krishnan V, Pandian SK. A combination of ellagic acid and tetracycline inhibits biofilm formation and the associated virulence of Propionibacterium acnes in vitro and in vivo. BIOFOULING 2016; 32:397-410. [PMID: 26930280 DOI: 10.1080/08927014.2016.1148141] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Propionibacterium acnes is an opportunistic pathogen which has become notorious owing to its ability to form a recalcitrant biofilm and to develop drug resistance. The current study aimed to develop anti-biofilm treatments against clinical isolates of P. acnes under in vitro and in vivo conditions. A combination of ellagic acid and tetracycline (ETC; 250 μg ml(-1) + 0.312 μg ml(-1)) was determined to effectively inhibit biofilm formation by P. acnes (80-91%) without affecting its growth, therefore potentially limiting the possibility of the bacterium attaining resistance. In addition, ETC reduced the production of extracellular polymeric substances (EPS) (20-26%), thereby making P. acnes more susceptible to the human immune system and antibiotics. The anti-biofilm potential of ETC was further substantiated under in vivo conditions using Caenorhabditis elegans. This study reports a novel anti-biofilm combination that could be developed as an ideal therapeutic agent with broad cosmeceutical and pharmaceutical applicability in the era of antibiotic resistance.
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Affiliation(s)
| | | | | | | | - Venkat Krishnan
- b Personal Care Division , ITC R&D Centre , Bengaluru , India
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von Graevenitz A. Importance of Coryneform Bacteria in Infective Endocarditis. Infect Dis Rep 2015; 7:6103. [PMID: 26500742 PMCID: PMC4593888 DOI: 10.4081/idr.2015.6103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/21/2015] [Indexed: 12/02/2022] Open
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Heckmann N, Sivasundaram L, Lieberman JR. Propionibacterium acnes Infection in the Native Hip: A Case Report. JBJS Case Connect 2015; 5:e60. [PMID: 29252848 DOI: 10.2106/jbjs.cc.n.00192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A sixty-five-year-old immunocompetent man with bilateral osteonecrosis of the hip and no prior surgical procedures or trauma was found to have a subacute Propionibacterium acnes infection of the femoral head. To our knowledge, this is the first reported case of Propionibacterium acnes infection in a native hip in the orthopaedic literature. CONCLUSION Diagnosing a subacute P. acnes infection can be challenging because of nonspecific clinical findings, normal laboratory values, and delayed growth of this organism on culture. Clinicians should maintain a high degree of suspicion as these infections are frequently missed.
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Affiliation(s)
- Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck Hospital of USC, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033.
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Revest M, Camou F, Senneville E, Caillon J, Laurent F, Calvet B, Feugier P, Batt M, Chidiac C. Medical treatment of prosthetic vascular graft infections: Review of the literature and proposals of a Working Group. Int J Antimicrob Agents 2015; 46:254-65. [PMID: 26163735 DOI: 10.1016/j.ijantimicag.2015.04.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/07/2015] [Accepted: 04/21/2015] [Indexed: 02/07/2023]
Abstract
More than 400000 vascular grafts are inserted annually in the USA. Graft insertion is complicated by infection in 0.5-4% of cases. Vascular graft infections (VGIs) are becoming one of the most frequent prosthesis-related infections and are associated with considerable mortality, ranging from 10 to 25% within 30 days following the diagnosis. Treatment of VGI is based on urgent surgical removal of the infected graft followed by prolonged antibiotherapy. Data regarding the best antibiotherapy to use are lacking since no well designed trial to study antimicrobial treatment of VGI exists. Moreover, since VGIs demonstrate very specific pathophysiology, guidelines on other material-related infections or infective endocarditis treatment cannot be entirely applied to VGI. A French multidisciplinary group gathering infectious diseases specialists, anaesthesiologists, intensivists, microbiologists, radiologists and vascular surgeons was created to review the literature dealing with VGI and to make some proposals regarding empirical and documented antibiotic therapy for these infections. This article reveals these proposals.
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Affiliation(s)
- M Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; CIC Inserm 1414, Rennes 1 University, Rennes, France
| | - F Camou
- Intensive Care Unit, Saint-André University Hospital, Bordeaux, France
| | - E Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, Lille 2 University, France
| | - J Caillon
- Bacteriology Department, EA 3826 Nantes University, Hôtel Dieu University Hospital, Nantes, France
| | - F Laurent
- Bacteriology Department, International Center for Infectiology Research (CIRI) - INSERM U1111, CNRS UMR5308, Lyon 1 University, ENS de Lyon, Hospices Civils de Lyon, Lyon, France
| | - B Calvet
- Anesthesiology Department, Beziers, France
| | - P Feugier
- Department of Vascular Surgery, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - M Batt
- Department of Vascular Surgery, University of Nice-Sophia Antipolis, Nice, France
| | - C Chidiac
- Infectious Diseases Department, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Inserm U1111, Lyon 1 University, Lyon, France.
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Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev 2015; 27:419-40. [PMID: 24982315 DOI: 10.1128/cmr.00092-13] [Citation(s) in RCA: 411] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Propionibacterium acnes is known primarily as a skin commensal. However, it can present as an opportunistic pathogen via bacterial seeding to cause invasive infections such as implant-associated infections. These infections have gained more attention due to improved diagnostic procedures, such as sonication of explanted foreign materials and prolonged cultivation time of up to 14 days for periprosthetic biopsy specimens, and improved molecular methods, such as broad-range 16S rRNA gene PCR. Implant-associated infections caused by P. acnes are most often described for shoulder prosthetic joint infections as well as cerebrovascular shunt infections, fibrosis of breast implants, and infections of cardiovascular devices. P. acnes causes disease through a number of virulence factors, such as biofilm formation. P. acnes is highly susceptible to a wide range of antibiotics, including beta-lactams, quinolones, clindamycin, and rifampin, although resistance to clindamycin is increasing. Treatment requires a combination of surgery and a prolonged antibiotic treatment regimen to successfully eliminate the remaining bacteria. Most authors suggest a course of 3 to 6 months of antibiotic treatment, including 2 to 6 weeks of intravenous treatment with a beta-lactam. While recently reported data showed a good efficacy of rifampin against P. acnes biofilms, prospective, randomized, controlled studies are needed to confirm evidence for combination treatment with rifampin, as has been performed for staphylococcal implant-associated infections.
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Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome. Eur J Clin Microbiol Infect Dis 2014; 34:527-34. [DOI: 10.1007/s10096-014-2256-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
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An HJ, Lee WR, Kim KH, Kim JY, Lee SJ, Han SM, Lee KG, Lee CK, Park KK. Inhibitory effects of bee venom on Propionibacterium acnes-induced inflammatory skin disease in an animal model. Int J Mol Med 2014; 34:1341-8. [PMID: 25215662 DOI: 10.3892/ijmm.2014.1933] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/01/2014] [Indexed: 11/06/2022] Open
Abstract
Propionibacterium acnes (P. acnes) is a major contributing factor to the inflammatory component of acne. The many prescription medications for acne allow for a large number of potential combination treatments. However, several antibiotics, apart from their antibacterial effects, exert side‑effects, such as the suppression of host inflammatory responses. Purified bee venom (BV) is a natural toxin produced by honeybees (Apis mellifera L.). BV has been widely used as a traditional medicine for various diseases. In the present study, to investigate the therapeutic effects of BV against P. acnes-induced inflammatory skin disease, P. acnes was intradermally injected into the ears of mice. After the injection, BV was applied to the skin surface of the right ear. Histological observation revealed that P. acnes induced a considerable increase in the number of infiltrated inflammatory cells. However, treatment with BV markedly reduced these reactions compared with the P. acnes-injected mice not treated with BV. Moreover, the expression levels of tumor necrosis factor (TNF)-α, and interleukin (IL)-1β were significantly reduced in the BV-treated mice compared with the untreated P. acnes-injected mice. In addition, treatment with BV significantly inhibited Toll-like receptor (TLR)2 and CD14 expression in P. acnes-injected tissue. The binding activity of nuclear factor-κB (NF-κB) and activator protein (AP)-1 was markedly suppressed following treatment with BV. The results from our study, using an animal model, indicate that BV exerts an inhibitory effect on inflammatory skin diseases. In conclusion, our data indicate that BV has potential for use as an anti-acne agent and may be useful in the pharmaceutical and cosmetics industries.
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Affiliation(s)
- Hyun-Jin An
- Department of Pathology, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Woo-Ram Lee
- Department of Pathology, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Kyung-Hyun Kim
- Department of Pathology, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Jung-Yeon Kim
- Department of Pathology, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sun-Jae Lee
- Department of Pathology, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sang-Mi Han
- Department of Agricultural Biology, National Institute of Agricultural Science and Technology, Wanju, Republic of Korea
| | - Kwang-Gill Lee
- Department of Agricultural Biology, National Institute of Agricultural Science and Technology, Wanju, Republic of Korea
| | - Chong-Kee Lee
- Department of Immunology, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Kwan-Kyu Park
- Department of Pathology, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
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Santo KRE, Franceschi V, Campos ACB, Monteiro TS, Barbosa GIF, Dantas A, Lamas CC. Pacemaker endocarditis caused by Propionibacterium acnes in an adult patient with Ebstein's anomaly: a report of a rare case. Heart Lung Circ 2014; 23:e222-5. [PMID: 25047281 DOI: 10.1016/j.hlc.2014.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/09/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
We report a rare case of a Brazilian adult woman with Ebstein's Anomaly who presented with pacemaker endocarditis caused by Propionibacterium acnes. Ebstein's Anomaly is a rare congenital malformation of the heart. Infective endocarditis is defined as an infection of heart valves, of the mural endocardium, of a septal defect, or of a cardiac electronic implantable device. Propionibacterium acnes is a skin commensal bacterium, that is usually considered as a contaminant, but can, on rare occasions, cause serious infections including endocarditis of prosthetic valves, native valves and cardiac electronic implantable devices. Diagnosis was made after nearly two years of investigation by identification of the organism by the MALDI-TOF technique and transoesophageal echocardiogram. The patient was successfully treated with daptomycin and device removal. She remains free of endocarditis after 32 months of follow-up.
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Affiliation(s)
- Karla R E Santo
- Department of Myocardium, Pericardium and Aorta Diseases, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.
| | - Vinicius Franceschi
- Department of Myocardium, Pericardium and Aorta Diseases, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - André C B Campos
- Department of Myocardium, Pericardium and Aorta Diseases, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Thaíssa S Monteiro
- Department of Myocardium, Pericardium and Aorta Diseases, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Giovanna I F Barbosa
- Department of Infection Control, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Angela Dantas
- Department of Microbiology, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Cristiane C Lamas
- Department of Infection Control, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil; Senior Lecturer, Unigranrio, Rio de Janeiro, Brazil; Infectious Diseases Inpatient Unit, Instituto de Pesquisa Clínica Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
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Kemp M, Bangsborg J, Kjerulf A, Schmidt TA, Christensen J, Irmukhamedov A6, Bruun NE, Dargis R, Andresen K, Christensen JJ. Advantages and limitations of ribosomal RNA PCR and DNA sequencing for identification of bacteria in cardiac valves of danish patients. Open Microbiol J 2013; 7:146-51. [PMID: 24403979 PMCID: PMC3883160 DOI: 10.2174/1874285801307010146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 11/29/2022] Open
Abstract
Studies on the value of culture-independent molecular identification of bacteria in cardiac valves are mostly restricted to comparing agreement of identification to what is obtained by culture to the number of identified bacteria in culture-negative cases. However, evaluation of the usefulness of direct molecular identification should also address weaknesses, their relevance in the given setting, and possible improvements. In this study cardiac valves from 56 Danish patients referred for surgery for infective endocarditis were analysed by microscopy and culture as well as by PCR targeting part of the bacterial 16S rRNA gene followed by DNA sequencing of the PCR product. PCR and DNA sequencing identified significant bacteria in 49 samples from 43 patients, including five out of 13 culture-negative cases. No rare, exotic, or intracellular bacteria were identified. There was a general agreement between bacterial identity obtained by ribosomal PCR and DNA sequencing from the valves and bacterial isolates from blood culture. However, DNA sequencing of the 16S rRNA gene did not discriminate well among non-haemolytic streptococci, especially within the Streptococcus mitis group. Ribosomal PCR with subsequent DNA sequencing is an efficient and reliable method of identifying the cause of IE, but exact species identification of some of the most common causes, i.e. non-haemolytic streptococci, may be improved with other molecular methods.
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Affiliation(s)
- Michael Kemp
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Herlev University hospital, Copenhagen, Denmark
| | - Anne Kjerulf
- Department of Clinical Microbiology, Herlev University hospital, Copenhagen, Denmark
| | | | - John Christensen
- Department of Cardiothoracic Surgery, Gentofte University Hospital, Copenhagen, Denmark
| | | | - Niels Eske Bruun
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Rimtas Dargis
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Keld Andresen
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
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Durante-Mangoni E, Mattucci I, Agrusta F, Tripodi MF, Utili R. Current trends in the management of cardiac implantable electronic device (CIED) infections. Intern Emerg Med 2013; 8:465-76. [PMID: 22744804 DOI: 10.1007/s11739-012-0797-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/26/2012] [Indexed: 10/28/2022]
Abstract
Cardiac implantable electronic device (CIED) infections are an emerging clinical problem. A growing number of dedicated and high quality clinical studies are currently being generated. We here review the most recent advances in the diagnosis and treatment of patients with CIED infection including intracardiac lead endocarditis. We discuss the current etiology and risk factors, and appraise the major diagnostic issues, describing our center's therapeutic approach. We also address the management of CIED infection complications.
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Affiliation(s)
- Emanuele Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples SUN, Naples, Italy
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Braun DL, Hasse BK, Stricker J, Fehr JS. Prosthetic valve endocarditis caused by Propionibacterium species successfully treated with coadministered rifampin: report of two cases. BMJ Case Rep 2013; 2013:bcr-2012-007204. [PMID: 23355561 DOI: 10.1136/bcr-2012-007204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe two cases of prosthetic valve endocarditis caused by Propionibacterium spp. successfully treated with a combination of rifampin and intravenous penicillin. Rifampin was chosen due to its promising activity against planktonic and biofilm Propionibacterium, its favourable minimal inhibitory concentrations, its excellent oral bioavailability and tissue penetration.
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Affiliation(s)
- Dominique Laurent Braun
- Divison of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Intrascrotal Abscess, Propionibacterium acnes and Staphylococcus cohnii ssp. cohnii: A Case Report and Review of the Literature. Case Rep Urol 2012; 2012:313694. [PMID: 23227417 PMCID: PMC3514819 DOI: 10.1155/2012/313694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/04/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction. The Propionibacterium acnes and the Staphylococcus cohnii ssp. cohnii are occasional pathogenic bacteria. The intrascrotal localization of the Propionibacterium acnes is exceptional. The Staphylococcus cohnii ssp. cohnii is not able to colonize the urogenital apparatus but it is the most frequently responsible for blood culture contamination even if it can sustain, in particular conditions, systemic infections. Case Presentation. We report the case of a 72-year-old man who is under observation for pain and swelling of the left hemiscrotum associated to high fever. The scrotal ultrasound shows the presence of a left intra-scrotal abscess with didymus, epididymis, and intact didymus-epididymis tunicae. The blood culture executed for evening fever during antibiotic therapy has underlined an infection with Propionibacterium acnes. A following blood culture has shown an increase in Staphylococcus cohnii ssp. cohnii. Due to fever the patient has undergone left orchifunicolectomy with inguino-scrotal toilet. The anatomical pathological examination has also shown the presence of nonspecific granulomatous inflammation compatible with Propionibacterium acnes infection. Conclusion. The onset of an intrascrotal abscess likely sustained by Propionibacterium acnes complicated by a possible systemic Staphylococcus cohnii ssp. cohnii suprainfection is an exceptional event that, in our case, has been resolved with surgical toilet.
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Noel W, Hammoudi N, Wegorowska E, D’Alessandro C, Steichen O. Pacemaker endocarditis caused by Propionibacterium acnes: A case report. Heart Lung 2012; 41:e21-3. [DOI: 10.1016/j.hrtlng.2012.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/03/2012] [Accepted: 04/05/2012] [Indexed: 10/28/2022]
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