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Propionibacterium Infections Treatment & Management

  • Author: Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Oct 07, 2015
 

Medical Care

Acne vulgaris [20]

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.[21] Empiric initial coverage with vancomycin plus ceftazidime, cefepime, or meropenem would be appropriate.

Other infections

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.

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Surgical Care

Acne vulgaris

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.[22] 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.[21]

Chronic pseudophakic-related endophthalmitis

This may require vitrectomy,[23] intravitreal vancomycin therapy, and replacement of the intraocular lens to ensure cure.[24]

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Consultations

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.

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Diet

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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Contributor Information and Disclosures
Author

Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI Director, Division of Hospital Medicine, Department of Medicine, Rhode Island Hospital

Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI is a member of the following medical societies: Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron Glatt, MD Chief Administrative Officer, Executive Vice President, Mercy Medical Center, Catholic Health Services of Long Island

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American Association for Physician Leadership, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.

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Propionibacterium infection. Nodular-cystic acne.
Propionibacterium infection. Pustular acne.
 
 
 
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