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Prosthetic valve endocarditis caused by Propionibacterium species: a national registry-based study of 51 Swedish cases

Journal article
Authors F. Lindell
B. Soderquist
K. Sundman
Lars Olaison
J. Kallman
Published in European Journal of Clinical Microbiology & Infectious Diseases
Volume 37
Issue 4
Pages 765-771
ISSN 0934-9723
Publication year 2018
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 765-771
Language en
Links dx.doi.org/10.1007/s10096-017-3172-...
Keywords infective endocarditis, antibiotic susceptibility, temporal trends, olmsted county, case series, acnes, surgery, contamination, bacteremia, skin, Infectious Diseases, Microbiology
Subject categories Infectious Medicine

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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