Persistent Cutibacterium (Formerly Propionibacterium) acnes Bacteremia and Refractory Endocarditis in a Patient with Retained Implantable Pacemaker Leads

Table 1

Overview of the circumstances surrounding each of the patients’ C. acnes-positive blood cultures, including those from this presentation.

Positive blood culture set (time prior to final diagnosis of infective endocarditis)	Reason for presentation/pertinent findings at presentation	Location presented to	Results of blood culture drawn at presentation	Days after being drawn that blood cultures resulted positive/speciated C.acnes	Was the patient admitted after initial presentation?	Did the patient receive TTE evaluating for infective endocarditis due to this presentation?	Did the patient receive antibiotics therapy or other related infectious management due to this presentation?	Were there management changes after return of positive blood cultures?	Reasoning for management plan following return of positive blood cultures	Was there noted acknowledgement of previous positive blood cultures?	Did the patient ever receive TEE in the evaluation of these blood culture results?
#1 (4 years prior)	Fevers, rigors, and leukocytosis	Emergency department	C.acnes in 2/2 anaerobic bottles	3/6	No	No	No	No changes in management	When the patient was followed up with 7 days after presentation, he had since been assessed by an outside physician and was currently asymptomatic. Positive blood cultures were not further addressed	n/a	No
#2 (3 years, 11 months prior)	Fevers and leukocytosis	Emergency department	C.acnes in 2/2 anaerobic bottles	4/9	No	No	Discharged with course of levofloxacin and out-patient follow-up with infectious disease	No changes in management	The patient was already taking antibiotics and had follow-up with infectious disease scheduled to determine etiology. Outcome of follow-up unknown, though the patient did not have another positive blood culture for 3 years after this admission	Yes, which helped guide recommendation to see out-patient infectious disease.	No
#3 (10 months prior)	Fevers, dental pain, and leukocytosis	Emergency department	C.acnes in 2/2 anaerobic bottles	5/7	No	No	Discharged with 10 days of course of penicillin and out-patient follow-up with oral surgery	No changes in management	Patient was already taking antibiotics and was planning to follow-up with oral surgery for a presumed dental infection	No	No
#4 (6 months prior)	Pleuritic chest pain, fevers, leukocytosis, and a chest X-ray showing left-sided infiltrate and a large left-sided pleural effusion	Emergency department	C.acnes in 1/2 anaerobic bottles	5/8	Yes	Yes, which was negative for infective endocarditis	Started empiric board-spectrum antibiotics at presentation for presumed pneumonia	Infectious disease consulted, a TTE was ordered, and repeat blood cultures were drawn	To evaluate for etiology of recurrent C.acnes bacteremia. No further evaluation was pursued after negative TTE, 2 subsequent sets of negative blood cultures, and the patient's symptomatic improvement. It was stated that the positive blood culture was likely the result of contamination, as only1/2 anaerobic bottles grew out C.acnes and the subsequent blood cultures were all negative	Yes, acknowledged “previous C.acnes-positive blood cultures of unclear etiology”.	No
#5 (1 month prior)	Undocumented	Skilled nursing facility	C.acnes in 2/2 anaerobic bottles	5/7	No	No	No	No changes in management	No noted actions taken after return of positive blood cultures, though the patient presented to the ED the following day	No	No
#6 (3 weeks prior)	Fevers, shortness of breath, and an erythematous, tender right chest fluctuance	Emergency department	C.acnes in 1/2 anaerobic bottles	4/6	No	No	No	No changes in management	Believed positive blood culture to be due to a contaminant	Yes, acknowledged “positive blood cultures from prior”.	No
#7 (1 week prior)	hypoglycemia, fevers, and an erythematous, tender right chest fluctuance	Emergency department	C.acnes in 2/2 anaerobic bottles	4/6	Yes	Yes, which was negative for infective endocarditis	Started empiric board-spectrum antibiotics at presentation for presumed sepsis	TEE was ordered	Suspicion for infection endocarditis despite negative TTE	Yes, which help guide decision to obtain TEE.	Yes, which showed vegetations on multiple pacemaker leads, the largest being 1 cm.