Cutibacterium acnes Infection in Orthopedics: Microbiology, Clinical Findings, Diagnostic Strategies, and Management

Abstract

Cutibacterium (formerly called Propionibacterium ) acnes is a human skin flora often implicated in orthopedic infections. The unique characteristics of this microorganism make the diagnosis of infection difficult. The diagnosis often is made based on clinical evidence, radiographic signs, and laboratory and/or surgical findings combined. Treatment often involves both pharmacologic and surgical methods. In addition, formation of biofilms and increased resistance to drugs exhibited by the microorganism can require combined antimicrobial therapy. Prophylactic measures are particularly important, but no single method has been shown to fully eliminate the risk of C acnes infections. Previous reports have focused on C acnes infections involving surgical implants or after certain orthopedic procedures, particularly in the shoulder and spine. This article reviews current clinical, diagnostic, and treatment principles for C acnes in orthopedics in general. [ Orthopedics . 2020; 43(1):52–61.]

The role of biofilm formation in the pathogenesis and antimicrobial susceptibility of Cutibacterium acnes

“…However, most evidence for a role of C. acnes in human disease comes from implant-associated infections [ 24 , [51] , [52] , [53] , [54] , [55] ]. The implementation of improved sampling techniques and diagnostic procedures over the last two decades has led to increased recovery of C. acnes from these infections and there is now convincing evidence that C. acnes biofilms are involved in infections related to the use of prosthetic joints, other orthopedic devices, cerebrovascular devices, breast implants, and cardiovascular devices.…”

A Janus-Faced Bacterium: Host-Beneficial and -Detrimental Roles of Cutibacterium acnes

“…Non-skin Diseases Associated With C. acnes C. acnes and Implant-Associated Infections More and more studies report the detection of C. acnes in IAIs. A few reviews have summarized the current knowledge regarding the role of C. acnes in IAIs (Portillo et al, 2013;Achermann et al, 2014;Aubin et al, 2014;Gharamti and Kanafani, 2017;Boisrenoult, 2018;Renz et al, 2018;Lin et al, 2020). It seems that C. acnes is now more often found in IAI-associated specimens than two decades ago.…”

“…acnes is associated with around 10% of all prosthetic joint infections (PJIs), being more frequently isolated in late-chronic infections (Benito et al, 2019;Triffault-Fillit et al, 2019). The shoulder is the most frequent site of isolation, probably due to the greater rate of colonization in the axillary region than in the hip or knee (Boisrenoult, 2018;Lin et al, 2020). It is now estimated that C. acnes accounts for 31-70% of all PJIs after shoulder arthroplasty (Fink and Sevelda, 2017).…”

“…The diagnosis of C. acnes-associated PJI is difficult, mainly due to the lack of specific local inflammatory signs at the surgical site of infection. Persistent unexplained pain is often the only symptom; evidence of implant loosening is seen in a great number of cases (Shah et al, 2015;Lin et al, 2020). Even though C. acnes is primarily associated with low-grade, chronic or delayed infections, it can also cause acute infections (Zeller et al, 2007;Dodson et al, 2010).…”

Detection of Cutibacterium (Propionibacterium) acnes in orthopaedic surgery: serious problem or contamination?

“…Resident skin bacteria such as Cutibacterium ( C. ) acnes (formerly Propionibacterium ( P. ) acnes ) are regularly found among the microbiological specimen in postoperative infections of the bone and of the soft tissues [ 1 , 2 ]. However, it often remains unclear whether the detection of C. acnes really reflects an infection or rather is merely an intraoperative contamination of the wound without the need for therapy.…”