title: Prosthetic valve endocarditis due to Propionibacterium acnes.
abstract: To study the characteristics of patients with Propionibacterium acnes prosthetic valve endocarditis (PVE) who required surgery.
  
  
  
  A single-centre retrospective cohort study was conducted during a 7-year period. Patients with definite infective P. acnes endocarditis, according to the modified Duke criteria, were included. An extended culture protocol was applied. Information on medical health status, surgery, antibiotic treatment and mortality was obtained.
  
  
  
  Thirteen patients fulfilled the criteria for P. acnes endocarditis (0.53% of 2466 patients with valve replacement in a 7-year period). All patients were male and had a previous valve replacement. The health status of patients was poor at diagnosis of P. acnes PVE. Most patients (11 of 13, 85%) were admitted with signs of heart failure due to a significant paravalvular leak; 2 of 13 (15%) patients presented with septic emboli. Twelve patients needed redo surgery, whereas one could be treated with antibiotic therapy only. The time between the index surgery and presentation with P. acnes PVE varied between 5 and 135 months (median 26.5 months). Replacement and reconstruction of the dysfunctional valve and affected anatomical structures was mainly performed with a mechanical valve (n = 5, 42%) or a (bio-) Bentall prosthesis (n = 6, 50%). Antibiotic therapy consisted of penicillin with or without rifampicin for 6 weeks after surgery. The mortality in this series was low (n = 1, 8%) and no recurrent endocarditis was found during a median follow-up of 38 months.
  
  
  
  Propionibacterium acnes PVE is a rare complication after valve surgery. Redo surgery is often required. Treatment of the dysfunctional prosthetic aortic valve most often consists of root replacement, in combination with antibiotic therapy.
authors.affiliation: Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands r.vanvalen@erasmusmc.nl.
authors.forename: Richard
authors.initials: R
authors.lastname: van Valen
authors.affiliation: Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands.
authors.forename: Robert A F
authors.initials: RA
authors.lastname: de Lind van Wijngaarden
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, Netherlands.
authors.forename: Nelianne J
authors.initials: NJ
authors.lastname: Verkaik
authors.affiliation: Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands.
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Mokhles
authors.affiliation: Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands.
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003141:Communicable Diseases; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000209:etiology*; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin
keywords: Cardiac surgery; Propionibacterium acnes; Prosthetic valve endocarditis