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Prosthetic valve endocarditis caused by Propionibacterium species: a national registry-based study of 51 Swedish
Fredrik Lindell1,2, Bo Söderquist3,4, Kristina Sundman4
1Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. fredrik.lindell@akademiska.se.
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.
Insights
Propionibacterium infective endocarditis (IE) primarily affects men with prosthetic valves. Early diagnosis and prolonged blood culture incubation are key, with benzylpenicillin as a recommended first-line treatment for a favorable outcome.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Propionibacterium species are an uncommon cause of infective endocarditis (IE).
- Diagnosis is challenging due to slow bacterial growth and potential misinterpretation as skin contamination.
- This study focuses on Propionibacterium spp. endocarditis within the Swedish national IE registry.
Purpose of the Study:
- To describe all cases of Propionibacterium spp. endocarditis in Sweden from 1995 to 2016.
- To analyze clinical characteristics, treatment strategies, and patient outcomes.
- To provide recommendations for diagnosis and management.
Main Methods:
- Retrospective analysis of the Swedish national registry of infective endocarditis.
- Inclusion criteria: definitive prosthetic valve endocarditis (PVE) caused by Propionibacterium spp.
- Data collection on patient demographics, clinical presentation, treatment, and outcomes.
Main Results:
- 51 episodes of Propionibacterium spp. PVE identified, representing 8% of PVE cases.
- The condition predominantly affected males (50/51), with a median of 3 years between surgery and diagnosis.
- High cure rate (92.1%) with benzylpenicillin as the most common antibiotic; 63% required cardiac surgery.
Conclusions:
- Propionibacterium spp. IE predominantly affects males with prosthetic valves.
- Prolonged blood culture incubation (up to 14 days) is recommended for prosthetic valve endocarditis diagnosis.
- Benzylpenicillin is the recommended first-line treatment, with a generally favorable prognosis despite high surgical rates.
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