Lumbar Spondylodiscitis Caused by Propionibacterium acnes After Epidural Obstetric Analgesia

Hérnández-Palazón, J; Jp, Puertas-García; Jf, Martínez-Lage; Ja, Tortosa Serrano

doi:10.1213/01.ane.0000055819.35383.d3

Cited by 17 publications

(12 citation statements)

References 9 publications

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“…Thirty-three of the 49 women (67%) had a caesarean delivery (either elective or non-elective) and had the epidural catheter retained for postoperative pain relief (median duration 43 h [IQR [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]). In 16 women (33%) the epidural catheter was used only during labour, for a median duration 11 h (IQR 5-22).…”

Section: Resultsmentioning

confidence: 99%

“…2,3,9,28 In organizing imaging, it is also important to remember that, as noted in our series, infection may be located in tissues adjacent to the epidural space, including the paravertebral space, paraspinal and adjacent muscles, [29][30][31] and nearby bone or disc. [32][33][34] Treatment of deep tissue infection involves aggressive antibiotic therapy, with or without surgical decompression within 6-12 h. 2 Empirical antibiotic treatment should cover species such as Staphylococcus aureus, Streptococci and Gram-negative bacilli, 3,9 and antibiotic treatment should continue for up to 6 weeks, extending to 8 weeks if osteomyelitis is present. 35 Conservative management without surgical drainage is an option in cases without neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Obstetric epidural catheter-related infections at a major teaching hospital: a retrospective case series

Green

Paech

2010

International Journal of Obstetric Anesthesia

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Obstetric epidural catheter-related infections at a major teaching hospital: a retrospective case series

Green

Paech

2010

International Journal of Obstetric Anesthesia

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“…The present review of the literature resulted in 15 reports concerning spondylodiscitis due to P. acnes, which, along with our own cases, are summarized in Table 1. Eleven articles were case reports [14][15][16][17][18][19][20][21][22][23][24] and five were case series [25][26][27][28][29], of which the largest involved four patients [26]. An additional report [29] revealed insufficient information.…”

Section: Discussionmentioning

confidence: 99%

Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature

Uçkay¹,

Dinh²,

Vauthey³

et al. 2010

Clinical Microbiology and Infection

100

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Propionibacterium acnes is the most frequent anaerobic pathogen found in spondylodiscitis. A documented case required microbiological proof of P. acnes with clinical and radiological confirmation of inflammation in a localized region of the spine. Microbiological samplings were obtained by surgery or aspiration under radiological control. Twelve males and 17 females (median age, 42 years) with spondylodiscitis due to P. acnes were diagnosed within the last 15 years. Three patients were immunosuppressed. All patients reported back pain as the main symptom, and most were afebrile. Three patients had a peripheral neurological deficit, one a motor deficit, and two a sensory deficit attributable to the infection; and six patients had an epidural abscess. The most frequent risk factor was surgery, which was present in the history 28 of 29 (97%) patients. The mean delay between spinal surgery and onset of disease was 34 months, with a wide range of 0-156 months. Osteosynthesis material was present in twenty-two cases (76%). In 24 (83%) patients, additional surgery, such as débridement or spondylodesis, was performed. Previous osteosynthesis material was removed in 17 of the 22 (77%) patients where it was present. Total cure was reported in all patients, except one, after a mean duration of antibiotic therapy of 10.5 weeks (range, 2-28 weeks). In conclusion, spondylodiscitis due to P. acnes is an acute infection closely related to previous surgery. The most prominent clinical feature is pain, whereas fever is rare, and the prognosis is very good.

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“…In addition to its well-established role in the pathogenesis of acnes vulgaris (16,34), it has also been linked to synovitis-acnes-pustulosis-hyperostosis-osteitis syndrome (44,54), sarcoidosis (17), and prostate cancer (14). Recent studies have revealed trauma and surgery as the predisposing factors associated with numerous P. acnes infections, which include brain abscesses (36), osteomyelitis after lumbar puncture (1), discitis after surgery (23), spodylodiscitis following epidural catheterization (22,25), postoperative mediastinitis (19,58), endophthalmitis (7), and endocarditis (21). Furthermore, it is also emerging as an important pathogen in infections related to medical foreign-body implants, such as intraocular lenses (65), ventroperitoneal shunts, orthopedic implants (9,28,51), silicone implants (2), prosthetic heart valves (33,42), and prosthetic joints (38,61).…”

mentioning

confidence: 99%

Propionibacterium acnes and Staphylococcus epidermidis Isolated from Refractory Endodontic Lesions Are Opportunistic Pathogens

Niazi

Clarke

et al. 2010

J Clin Microbiol

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The predominant cultivable microbiota from 20 refractory endodontic lesions (9 with abscesses and 11 without abscesses) were determined, and Propionibacterium acnes and Staphylococcus epidermidis were among the most predominant organisms. The number of species identified from lesions with abscesses (14.1 ؎ 2.6) was significantly greater (P < 0.001) than the number from lesions without abscesses (7.4 ؎ 5.9). Comparison of perioral isolates using repetitive extragenic palindromic PCR of the same species from the same subjects demonstrated that the endodontic and skin populations were significantly different. The P. acnes isolates were typed on the basis of recA gene sequence comparison, and only three types (types I, II, and III) were identified among 125 isolates examined. However, we found that type I (type IA and IB) isolates were primarily isolated from the skin, while types II and III were significantly more likely to be isolated from the endodontic lesions (P < 10 ؊10 ). We found that the robustness of the recA phylotypes was not strong by comparing the partial gene sequences of six putative virulence determinants, PAmce, PAp60, PA-25957, PA-5541, PA-21293, and PA-4687. The resulting neighbor-joining trees were incongruent, and significant (phi test; P ‫؍‬ 2.2 ؋ 10 ؊7 ) evidence of recombination was demonstrated, with significant phylogenetic heterogeneity being apparent within the clusters. P. acnes and S. epidermidis isolated from refractory endodontic infections, with or without periapical abscesses, are likely to be nosocomial infections.Propionibacterium acnes and coagulase-negative staphylococci, including Staphylococcus epidermidis, have been identified among the microflora of endodontic infections (8,12,40,50,52,55,56,63,64), but their importance as endodontic pathogens has largely been ignored due to their nearly universal presence on the skin and the consequent likelihood of sample contamination. However, there is now considerable evidence that these organisms are increasingly isolated from human infections, and so their association with endodontic infections requires clarification. P. acnes, a non-spore-forming, Gram-positive anaerobic or aerotolerant rod, is a member of the resident microflora of the large intestine, conjunctiva, and external ear canal (10, 15) and accounts for approximately half of the total skin microbiota (59), predominating over other pilosebaceous flora (16,39). Although traditionally considered to be relatively nonpathogenic, an increasing number of studies have implicated P. acnes as an opportunistic pathogen responsible for a wide range of infections and inflammatory conditions. In addition to its well-established role in the pathogenesis of acnes vulgaris (16, 34), it has also been linked to synovitis-acnes-pustulosis-hyperostosis-osteitis syndrome (44, 54), sarcoidosis (17), and prostate cancer (14). Recent studies have revealed trauma and surgery as the predisposing factors associated with numerous P. acnes infections, which include brain abscesses (36), osteomyelitis ...

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Lumbar Spondylodiscitis Caused by Propionibacterium acnes After Epidural Obstetric Analgesia

Cited by 17 publications

References 9 publications

Obstetric epidural catheter-related infections at a major teaching hospital: a retrospective case series

Obstetric epidural catheter-related infections at a major teaching hospital: a retrospective case series

Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature

Propionibacterium acnes and Staphylococcus epidermidis Isolated from Refractory Endodontic Lesions Are Opportunistic Pathogens

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