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Three cases of Cutibacterium avidum prosthetic valve infective endocarditis at a single heart center
Niels Nørskov-Lauritsen1, Lars P S Riber2, Esad Dzajic3
1Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark.
Insights
Cutibacterium avidum prosthetic valve endocarditis is rare but challenging to detect. This study investigated a cluster, finding the bacteria difficult to culture, suggesting it may be underreported in culture-negative cases.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Prosthetic valve infective endocarditis (IE) is a serious complication after cardiac surgery.
- Cutibacterium avidum (C. avidum) is an emerging pathogen in IE, particularly after aortic valve replacement.
- An unusual cluster of C. avidum IE cases prompted this investigation.
Purpose of the Study:
- To investigate an exceptional clustering of C. avidum prosthetic valve IE at a single heart center.
- To identify potential sources and transmission routes of C. avidum in post-operative IE.
- To improve the diagnostic approach for C. avidum IE.
Main Methods:
- Retrospective analysis of three patients with C. avidum bacteremia following aortic valve replacement over 21 months.
- Review of operative procedures and antimicrobial prescriptions.
- Whole-genome sequencing of bacterial isolates to assess genetic relatedness.
Main Results:
- All three patients developed C. avidum bacteremia 24-128 days post-aortic valve replacement.
- Prosthetic valves were implanted by different surgical teams, ruling out a single surgical team as the source.
- Whole-genome sequencing identified a distinct C. avidum subgroup but did not indicate patient-to-patient transmission.
Conclusions:
- Detection of C. avidum in prosthetic valve endocarditis can be challenging, with inconsistent results from blood cultures and PCR.
- C. avidum may be an underreported cause of culture-negative prosthetic valve endocarditis.
- Meticulous investigation for C. avidum is recommended in culture-negative prosthetic valve endocarditis cases.
Objective:
To resolve an exceptional clustering of Cutibacterium avidum prosthetic valve infective endocarditis (IE) at a single heart center.
Methods:
During a period of 21 months, three patients experienced C. avidum bacteremia 24-128 days after aortic valve replacement. Operative procedures and electronic prescriptions of antimicrobials were surveyed, and bacterial isolates were genome sequenced.
Results:
The prosthetic valves were inserted by separate surgical teams. In one case, echocardiographic confirmation of IE was not achieved until 4 months after the first positive blood culture, but the causative agents were irrefutably documented in all cases by culture, or amplification of bacterial deoxyribonucleic acid, from removed prosthetic material. Whole-genome sequencing clustered isolates to a distinctive subgroup of the species but did not suggest inter-patient transmission of isolates.
Conclusions:
Despite vigorous sampling of blood and tissue, detection of C. avidum was not unconditional, neither by culture nor polymerase chain reaction test. The causative agent is likely underreported and should be meticulously searched for in culture-negative prosthetic valve endocarditis.
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