Cardiovascular Implantable Electronic Device Infections due toPropionibacteriumSpecies

Abstract

Introduction Propionibacterium species are part of the normal skin flora and often considered contaminants when identified in cultures. However, they can cause life-threatening infections, including prosthetic cardiovascular device infections. Clinical presentation and management of cardiovascular implantable electronic device (CIED) infection due to Propionibacterium species has not been well described. Methods Retrospective review of all cases of CIED infection due to Propionibacterium species admitted to Mayo Clinic between January 1, 1990 and December 31, 2014. Patient charts were reviewed for clinical, microbiological, and imaging data. Descriptive analysis was performed. Results We identified 14 patients with CIED infection due to Propionibacterium species, accounting for 2.3% of all CIED infections. Patients were predominantly male (n=12, 86%). The median age at admission was 58.5 years [range, 22–83]. Twelve patients had implantable cardioverter-defibrillators (ICDs) and 2 had permanent pacemaker (PPM) systems. Twelve patients had generator pocket infection (86%). Two patients met clinical criteria for CIED-related infective endocarditis (CIED-IE). Median time between last device manipulation and infection was 9 months [range, 1–98]. All patients were treated with complete device removal and antibiotic therapy. Six-month follow-up data were available for 10 patients (71%), with no relapses documented. Conclusion CIED infections due to Propionibacterium species accounted for 2.3% of all device infections over a 25-year period. The most common infectious syndrome was generator pocket infection with delayed onset. There was an unanticipated predominance of ICDs in this cohort. Cure was achieved in all cases with complete device removal and antibiotic therapy.

Cardiac Implantable Electronic Device Infections; Long-Term Outcome after Extraction and Antibiotic Treatment

“…However, in a Danish study, CoNS was the major microbial finding both in patients with systemic infection and in those with pocket infection [ 14 ]. C. acnes was found in 17.3% of the patients with pocket infection in our study, and has been described as a causative agent in CIED pocket infections [ 15 ].…”

How to study biofilms: technological advancements in clinical biofilm research

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