Propionibacterium Infections Treatment & Management
- Author: Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI; Chief Editor: Mark R Wallace, MD, FACP, FIDSA more...
Acne vulgaris 
Topical and oral agents act at various stages in the evolution of an acne lesion and may be used alone or in combination to enhance efficacy. Most cases of acne vulgaris are controlled with combinations of oral or topical vitamin A derivatives, topical benzoyl peroxide, oral or topical antibiotics, and topical beta-hydroxy acids such as salicylic acid. Topical agents should be applied to the entire affected area to treat existing lesions and to prevent the development of new ones. Topical steroid creams should not be used to treat acne because their long term use is associated with the development of acne-like lesions. Photodynamic therapy is another promising therapy that is being further evaluated.
CNS shunt infections
Device removal is indicated for CNS shunt infections, and antibiotic treatment should be focused once results of Gram staining and culture are available. Empiric initial coverage with vancomycin plus ceftazidime, cefepime, or meropenem would be appropriate.
Determination of the clinical significance of an isolate of Propionibacterium species must be made with caution because this will influence the need to direct therapy against that isolate.
Transfusion-transmitted bacterial infection
This requires stoppage of the blood transfusion, resuscitation of the patient, and, if suspicion is high, administration of empiric broad-spectrum antibiotics until results are available. A typical combination would be intravenous vancomycin and gentamicin.
Surgical care involves manual removal of comedones and drainage of pustules and cysts. When performed correctly, acne surgery speeds resolution and rapidly enhances cosmetic appearance. Scar revision via dermabrasion, excision, subcicion, or laser therapy may be performed. Inflamed papules and cysts may be injected with intralesional steroids. Risks include hypopigmentation and skin atrophy.
Cardiovascular device–related infections
Removal of the device is usually recommended. Bacteremia without a clear source may warrant an aggressive course of intravenous antibiotic therapy.
CNS shunt infections
Device removal, external drainage, and subsequent shunt replacement should be performed once the CSF is sterile.
Chronic pseudophakic-related endophthalmitis
Acne vulgaris: Referral to a dermatologist may be appropriate for patients who do not respond to conventional treatment.
Other infections: Isolation of Propionibacterium species in the settings described above may require the assistance of an infectious diseases specialist for interpretation.
In cases of acne vulgaris, there may be a correlation between foods with a high glycemic index and development of acne. Consumption of a diet with low glycemic index foods may be reasonable if the patient feels that diet is aggravating the condition.
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