Prosthetic valve endocarditis due to Propionibacterium acnes

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiac Surgery

Background:

• Propionibacterium acnes prosthetic valve endocarditis (PVE) is a rare but serious complication following valve replacement surgery.
• Early diagnosis and appropriate management are crucial for patient outcomes.

Purpose of the Study:

• To investigate the clinical characteristics of patients with P. acnes PVE who underwent surgical intervention.
• To identify key factors influencing treatment decisions and patient prognosis.

Main Methods:

• A retrospective cohort study was conducted over 7 years at a single center.
• Patients with definite P. acnes PVE, confirmed by modified Duke criteria and extended cultures, were included.
• Data on patient health status, surgical procedures, antibiotic regimens, and mortality were collected.

Main Results:

• P. acnes PVE occurred in 0.53% of valve replacement patients, predominantly affecting males with prior valve surgery.
• Most patients presented with heart failure due to paravalvular leak (85%) or septic emboli (15%).
• Redo surgery was necessary for 12 out of 13 patients, with valve root replacement being a common procedure. Mortality was low (8%).

Conclusions:

• P. acnes PVE is an uncommon but significant complication post-valve surgery, frequently necessitating repeat surgical intervention.
• Management often involves prosthetic valve replacement, particularly aortic root replacement, combined with targeted antibiotic therapy.
• The study highlights the importance of considering P. acnes in prosthetic valve endocarditis cases and the generally favorable outcomes with timely surgical and antibiotic treatment.