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[Propionibacterium acnes in the etiology of endocarditis]
E Abramczuk1, I Rawczyńska-Englert, J Meszaros
1I Kliniki Wad Serca instytutu Kardiologii, Warszawie.
Abstract:
Propionibacterium acnes is the gram positive anaerobic bacteria belongs to the normal skin and oral microbial flora. The participation of this microorganism in the infective endocarditis is still controversial. The aim of the study was to perform the diagnostic and therapeutic difficulties in 5 patients with infective endocarditis caused by Propionibacterium acnes. In 3 out of 5 patients the infective endocarditis developed after prosthesis valve replacement, in 2 others on the native valves. The inserted prostheses were mechanical ones, propionibacterium acnes was identified as causative organisms in all of the causes (two positive blood and/or valve culture). The bacterial strains were sensitive to the antibiotics as: penicillins, cephalosporins, clindamycin, and vancomycin, however cephalosporins used at the beginning of the treatment in 3 patients and clindamycin in 1 patient had limited clinical efficacy. Later treatment with timentin, augmentin and tienamycin was successful in 3 patients; one patient was cured with vancomycin. One patient died because of septic, embolic complication in early stage of illness. We conclude the effectiveness of penicillins in combination with clavulanic acid and tienamycin in therapy of infective endocarditis due to Propionibacterium acnes. The treatment should be lasted during 4-6 weeks.
Insights
Propionibacterium acnes can cause infective endocarditis, particularly after valve replacement. Effective treatment involves specific antibiotics like penicillin combined with clavulanic acid or tienamycin for 4-6 weeks.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Propionibacterium acnes, a common skin bacterium, has a controversial role in infective endocarditis.
- This study investigates the diagnostic and therapeutic challenges of P. acnes endocarditis.
Observation:
- Five patients with P. acnes endocarditis were analyzed, with 3 cases occurring post-prosthetic valve replacement (mechanical valves) and 2 on native valves.
- P. acnes was identified via blood and/or valve cultures in all cases.
- Initial antibiotic treatments (cephalosporins, clindamycin) showed limited efficacy.
Findings:
- Bacterial strains were sensitive to penicillins, cephalosporins, clindamycin, and vancomycin.
- Successful treatment was achieved with amoxicillin-clavulanate (Augmentin), ticarcillin-clavulanate (Timentin), and tienamycin in 3 patients.
- One patient responded to vancomycin; another died from septic and embolic complications.
Implications:
- Penicillin combined with clavulanic acid or tienamycin demonstrates effectiveness for P. acnes endocarditis.
- A treatment duration of 4-6 weeks is recommended.
- Highlights the importance of considering P. acnes in endocarditis, especially in prosthetic valve cases.