Cutibacterium (Propionibacterium) Infections Treatment & Management

Updated: Dec 03, 2019
  • Author: Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI; Chief Editor: John L Brusch, MD, FACP  more...
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Treatment

Medical Care

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 (see Surgical Care), and antibiotic treatment should be focused once results of Gram staining and culture are available. [23] Empiric initial coverage with vancomycin plus ceftazidime, cefepime, or meropenem would be appropriate.

Other infections

Determination of the clinical significance of an isolate of Cutibacterium 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, subcision, or laser therapy may be performed. Inflamed papules and cysts may be injected with intralesional steroids. Risks include hypopigmentation and skin atrophy.

General recommendations for implant-associated infections

Owing to the variable clinical presentation of C acnes implant-associated infections, there is no general consensus on best treatment. Surgical recommendations, however, should not differ dramatically from infections caused by other microorganisms. Implant-associated infections require surgical removal of the infected implant and debridement of any infected tissue and dead bone. As C acnes infection typically has a delayed presentation following implant surgery, extensive and aggressive debridement of all infected tissue with removal of the implant is recommended. Surgical therapy needs to be accompanied by prolonged antibiotic treatment in order to ensure eradication of remaining bacteria. For most prosthetic joint infections, a 3- to 6-month course of antibiotic treatment is suggested, including 2-6 weeks of intravenous treatment with a beta-lactam, depending on implant size. [6]

Cardiovascular device–related infections

Removal of the device is usually recommended. [24] 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. [23]

Chronic pseudophakic-related endophthalmitis

This may require vitrectomy, [25] intravitreal vancomycin therapy, and replacement of the intraocular lens to ensure cure. [26]

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Consultations

Acne vulgaris

The goals of therapy in acne vulgaris include reduction of comedonal and inflammatory lesions, improvement of psychosocial symptoms, and avoidance of scarring. The duration of therapeutic intervention for acne vulgaris should be at least 8 weeks to assess effectiveness, unless the patient has an allergy or experiences intolerable adverse effects. If the patient shows inadequate improvement after sequential interventions, referral to a dermatologist is recommended. [27]

Other infections

Isolation of Cutibacterium species in the settings described above may require the assistance of an infectious diseases specialist for interpretation.

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Diet

Acne vulgaris

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. In addition, avoidance of dairy, including skim milk, is recommended, as it may reduce the number of skin lesions. [27]

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