Propionibacterium sp. are part of the normal skin flora, and are often considered a contaminant when identified in cultures. However, Propionibacterium sp. have been implicated in prosthesis infections including prosthetic valve endocarditis. Clinical presentation and management of Cardiac Implanted Electronic Device (CIED) infection due to Propionibacterium sp. has not been well characterized.
We searched all cases of CIED infection in Mayo Clinic device database from 1990 to 2014 for Propionibacterium infection in adults (age ≥18 years). CIED infection was defined as the presence of signs and symptoms of device infection with positive cultures from pocket site, device lead, or blood for Propionibacterium sp. CIED-related infective endocarditis (IE) was defined using the modified Duke Criteria.
We identified 15 cases of CIED infection due to Propionibacterium sp., which accounted for 2.4% of all CIED infections over the study period (n=618). Majority 12 (80%) were males and median age was 62 years [range, 22-83]. Most patients 13 (87%) had ICDs while 2 patients (13%) had a PPM. Median time between device placement and infection was 11 months [range, 1-136], 60% occurred within one year of implantation. Pocket infection 11 (73%) was the most common presentation; 2 patients had device erosion through the skin, 1 pocket infection with bacteremia, and 1 CIED related IE. Ten patients (67%) had positive culture from device pocket, 8 (44%) from lead, and 2 (13%) from blood.
All patients underwent device removal but two (13%) had partial removal only. Patients received either vancomycin (n=6) or a beta-lactam (n=9) therapy. Median duration of antibiotic therapy was 15 days [range, 10-38]. Fourteen patients (93%) had a new device implanted. Eleven (73%) were followed for 150 days; and 6 patients had 1 year follow up. None had relapse of infection.
Propionibacterium CIED infection is uncommon and occurred in 2.4% of total CIED infections. Most infections occurred within the first year after device placement. Pocket site infection was the most common presentation. Cure rate with device removal and antibiotic therapy was 100%. Despite the recognized increase in ICD placement for primary prophylaxis of potentially lethal ventricular dysrhythmias, the predominance of ICD infections in this cohort was unanticipated.
A. El Rafei,
M. R. Sohail, Tyrex: Consultant , Research support
J. Steckelberg, None
W. R. Wilson, None
L. Baddour, None