title: Propionibacterium acnes endocarditis: a case series.
abstract: OBJECTIVE
  Propionibacterium acnes remains a rare cause of infective endocarditis (IE). It is challenging to diagnose due to the organism's fastidious nature and the indolent presentation of the disease. The purpose of this study was to describe the clinical presentation and management of P. acnes IE with an emphasis on the methods of diagnosis.
  
  
  METHODS
  We identified patients from the Cleveland Clinic Infective Endocarditis Registry who were admitted from 2007 to 2015 with definite IE by Duke Criteria. Propionibacterium acnes was defined as the causative pathogen if it was identified in at least two culture specimens, or identified with at least two different modalities: blood culture, valve culture, valve sequencing or histopathological demonstration of microorganisms.
  
  
  RESULTS
  We identified 24 cases of P. acnes IE, 23 (96%) of which were either prosthetic valve endocarditis or IE on an annuloplasty ring. Invasive disease (71%) and embolic complications (29%) were common. All but one patient underwent surgery. Propionibacterium acnes was identified in 12.5% of routine blood cultures, 75% of blood cultures with extended incubation, 55% of valve cultures, and 95% of valve sequencing specimens. In 11 of 24 patients (46%), no causative pathogen would have been identified without valve sequencing.
  
  
  CONCLUSIONS
  Propionibacterium acnes almost exclusively causes prosthetic valve endocarditis and patients often present with advanced disease. The organism may not be readily cultured, and extended cultures appear to be necessary. In patients who have undergone surgery, valve sequencing is most reliable in establishing the diagnosis.
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA. Electronic address: banzonj@ccf.org.
authors.forename: J M
authors.initials: JM
authors.lastname: Banzon
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rehm
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Gordon
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Hussain
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: G B
authors.initials: GB
authors.lastname: Pettersson
authors.affiliation: Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA. Electronic address: shrestn@ccf.org.
authors.forename: N K
authors.initials: NK
authors.lastname: Shrestha
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation; D004697:Endocarditis, Bacterial / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D006350:Heart Valve Prosthesis / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012042:Registries; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Blood culture; Endocarditis; Propionibacterium; Prosthetic valve; Valve sequencing