{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:49:52Z","timestamp":1790232592249,"version":"4.1.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi230684-4\"><jats:title>Importance<\/jats:title><jats:p>It is suggested that patients with <jats:italic>Cutibacterium acnes<\/jats:italic> endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed this statement.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230684-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the clinical characteristics and outcomes of patients with <jats:italic>C acnes<\/jats:italic> endocarditis.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230684-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A case series of 105 patients presenting to 7 hospitals in the Netherlands and France (4 university hospitals and 3 teaching hospitals) with definite endocarditis according to the modified Duke criteria between January 1, 2010, and December 31, 2020, was performed. Clinical characteristics and outcomes were retrieved from medical records. Cases were identified by blood or valve and prosthesis cultures positive for <jats:italic>C acnes<\/jats:italic>, retrieved from the medical microbiology databases. Infected pacemaker or internal cardioverter defibrillator lead cases were excluded. Statistical analysis was performed in November 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230684-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Main outcomes included symptoms at presentation, presence of prosthetic valve endocarditis, laboratory test results at presentation, time to positive results of blood cultures, 30-day and 1-year mortality rates, type of treatment (conservative or surgical), and endocarditis relapse rates.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230684-8\"><jats:title>Results<\/jats:title><jats:p>A total of 105 patients (mean [SD] age, 61.1 [13.9] years; 96 men [91.4%]; 93 patients [88.6%] with prosthetic valve endocarditis) were identified and included. Seventy patients (66.7%) did not experience fever prior to hospital admission, nor was it present at hospitalization. The median C-reactive protein level was 3.6 mg\/dL (IQR, 1.2-7.5 mg\/dL), and the median leukocyte count was 10.0\u2009\u00d7\u200910<jats:sup>3<\/jats:sup>\/\u00b5L (IQR, 8.2-12.2\u2009\u00d7\u200910<jats:sup>3<\/jats:sup>\/\u00b5L). The median time to positive blood culture results was 7 days (IQR, 6-9 days). Surgery or reoperation was indicated for 88 patients and performed for 80 patients. Not performing the indicated surgical procedure was associated with high mortality rates. Seventeen patients were treated conservatively, in accordance with the European Society of Cardiology guideline; these patients showed relatively high rates of endocarditis recurrence (5 of 17 [29.4%]).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230684-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This case series suggests that <jats:italic>C acnes<\/jats:italic> endocarditis was seen predominantly among male patients with prosthetic heart valves. Diagnosing <jats:italic>C acnes<\/jats:italic> endocarditis is difficult due to its atypical presentation, with frequent absence of fever and inflammatory markers. The prolonged time to positivity of blood culture results further delays the diagnostic process. Not performing a surgical procedure when indicated seems to be associated with higher mortality rates. For prosthetic valve endocarditis with small vegetations, there should be a low threshold for surgery because this group seems prone to endocarditis recurrence.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.23112","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T15:02:46Z","timestamp":1689174166000},"page":"e2323112","source":"Crossref","is-referenced-by-count":24,"title":["Clinical Characteristics and Outcomes of Patients With <i>Cutibacterium acnes<\/i> Endocarditis"],"prefix":"10.1001","volume":"6","author":[{"given":"Floris J.","family":"Heinen","sequence":"first","affiliation":[{"name":"Department of Cardiology, Haga Hospital, Den Haag, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florent","family":"Arregle","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Assistance Publique\u2013H\u00f4pitaux de Marseille, La Timone Hospital, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris S.","family":"van den Brink","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Ajmone Marsan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Bernts","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Amsterdam UMC, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Houthuizen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otto","family":"Kamp","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nienke","family":"Roescher","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, St Antonius Hospital, Nieuwegein, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Timmermans","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelianne","family":"Verkaik","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Erasmus University Medical Center, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolien","family":"Roos-Hesselink","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco C","family":"Post","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Utrecht University Medical Center, Utrecht, the Netherlands"},{"name":"Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert","family":"Habib","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Assistance Publique\u2013H\u00f4pitaux de Marseille, La Timone Hospital, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilco","family":"Tanis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Haga Hospital, Den Haag, the Netherlands"},{"name":"Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,7,12]]},"reference":[{"issue":"6","key":"zoi230684r2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcr\/ytab148","article-title":"Recurrent strokes in an occult case of recurrent Cutibacterium acnes prosthetic valve infective endocarditis: a case report.","volume":"5","author":"Fry","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"zoi230684r3","doi-asserted-by":"publisher","DOI":"10.1016\/S1885-5857(09)71535-X","author":"Gu\u00edo","year":"2009","journal-title":"Rev Esp Cardiol"},{"issue":"4","key":"zoi230684r4","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis.","volume":"30","author":"Li","year":"2000","journal-title":"Clin Infect 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diversity of the human skin microbiome.","volume":"324","author":"Grice","year":"2009","journal-title":"Science"},{"key":"zoi230684r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.bioflm.2021.100063","article-title":"The role of biofilm formation in the pathogenesis and antimicrobial susceptibility of Cutibacterium acnes.","volume":"4","author":"Coenye","year":"2021","journal-title":"Biofilm"},{"issue":"8-9","key":"zoi230684r14","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1016\/j.acvd.2021.01.004","article-title":"Infective endocarditis with neurological complications: delaying cardiac surgery is associated with worse outcome.","volume":"114","author":"Arregle","year":"2021","journal-title":"Arch Cardiovasc Dis"},{"issue":"6","key":"zoi230684r15","doi-asserted-by":"publisher","first-page":"630","DOI":"10.21037\/acs","article-title":"Current AATS guidelines on surgical treatment of infective 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SM, Goyal? A, Patel? BC. C reactive protein. In: StatPearls. StatPearls Publishing; 2022. Updated July 18, 2022. Accessed June 5, 2023. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441843\/"},{"key":"zoi230684r12","unstructured":"Martel? JL, Miao? JH, Badri? T. Anatomy, hair follicle. In: StatPearls. StatPearls Publishing; 2022. Udated October 10, 2022. 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