title: [Propionibacterium granulosum bare-metal stent infection after drug-eluting balloon].
abstract: BACKGROUND
  Bare-metal stents are used to treat arterial stenotic lesions. Morbidity and mortality are less important compared with other techniques. Drug-eluting balloons are often used to treat stent stenosis. We reported the case of a bare-metal stent infection after drug-eluting balloon and a review on the subject.
  
  
  METHODS
  Two weeks after percutaneous transluminal angioplasty with paclitaxel-eluting balloon and a bare-metal stent, our patient presented an infection of the stent. Diagnosis was based on the clinical presentation, positron emission tomography findings and isolation of Propionibacterium granulosum in repeated blood cultures. Adapted antibiotic therapy was given for three months with removal of the surgical bare-stent. Antibiotic therapy was interrupted after a second positron emission tomography. A literature search (PubMed and Cochrane) was performed on the subject.
  
  
  RESULTS
  We found 49 cases of peripheral bare-metal stent infection including our patient. This is a rare but serious complication with a high morbidity (25% amputation rate) and mortality (30%). It seems to be underestimated. Treatment is based on surgical ablation of the bare-metal stent and intravenous antibiotics. The role of the paclitaxel-eluting balloon is not clearly established but some authors believe that it can produce a local immunosuppression.
  
  
  CONCLUSIONS
  We report the first case of bare-metal stent infection after paclitaxel-eluting balloon. This complication is rare and difficult to diagnose. Manifestations are often limited to skin signs. Functional and vital prognosis is poor.
authors.affiliation: Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France. Electronic address: jacques.hernigou@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Hernigou
authors.affiliation: Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France.
authors.forename: A
authors.initials: A
authors.lastname: Gordienco
authors.affiliation: Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France.
authors.forename: B
authors.initials: B
authors.lastname: Dakhil
authors.affiliation: Unité mobile d'infectiologie, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France.
authors.forename: P
authors.initials: P
authors.lastname: Longuet
authors.affiliation: Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Couffinhal
authors.affiliation: Service de chirurgie vasculaire et thoracique, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95107 Argenteuil, France.
authors.forename: P
authors.initials: P
authors.lastname: Bagan
mesh_terms: D000369:Aged, 80 and over; D000497:Alloys; D000658:Amoxicillin / Q000627:therapeutic use; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001162:Arteriosclerosis Obliterans / Q000150:complications / Q000601:surgery; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology; D003327:Coronary Disease / Q000150:complications / Q000628:therapy; D023903:Coronary Restenosis / Q000628:therapy; D020878:Device Removal; D004866:Equipment Contamination; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005839:Gentamicins / Q000627:therapeutic use; D016908:Gram-Positive Bacterial Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011424:Propionibacterium / Q000302:isolation & purification* / Q000472:pathogenicity; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D015607:Stents / Q000009:adverse effects*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000497:Alloys; D000900:Anti-Bacterial Agents; D005839:Gentamicins; D007166:Immunosuppressive Agents; D000077725:Piperacillin, Tazobactam Drug Combination; C013616:nitinol; D000658:Amoxicillin; D010397:Penicillanic Acid; D017239:Paclitaxel; D010878:Piperacillin
keywords: Bacteremia; Bactériémie; Ballon actif; Bare-metal stent; Drug-eluting balloon; Propionibacterium granulosum; Stent artériel