Propionibacterium acnes Wound Contamination at the Time of Spinal Surgery

Abstract

Bacteria of the normal skin microbiota such as Propionibacterium acnes and coagulase-negative staphylococci often are dismissed as contaminants when detected in clinical samples. Propionibacterium acnes is described as a cause of spinal infection and more recently has been linked to sciatica. To date no researchers formally have examined the incidence of bacterial wound contamination during spinal surgery. Surgical specimens were removed from 79 patients having spinal surgery for analysis using agar culture detection, broth enrichment, and immunofluorescence microscopy. Bacteria were identified in 29.1% of skin samples, 21.5% of tissue samples and 16.5% of washings retrieved from operative wounds. Propionibacterium acnes was identified more frequently than Staphylococcus spp in each of the three sample types. Bacteria were detected using enrichment in 9 (11%) patients and using fluorescence microscopy in 15 (19%). The results of immunofluorescence microscopy suggest that Propionibacterium acnes detected in wounds originates from patient skin. Bacteria from contaminated wounds appeared as single cells using fluorescence microscopy; however previous work shows that bacteria from infected hip prosthesis are observed as large aggregates. Therefore, it is suggested that immunofluorescence microscopy is a useful tool to help discriminate between surgical contamination and infection. Level of Evidence: Diagnostic study, Level I (prospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

“…P ropionibacterium species are often grown on culture of specimens obtained at the time of orthopaedic revision surgery. The pathogenicity of this organism has been demonstrated for patients who have undergone shoulder implant surgery [1][2][3][4][5][6][7][8][9][10][11][12][13][14] , hip or knee arthroplasty [15][16][17][18][19][20][21][22] , or spine surgery [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] . While many cases of Propionibacterium infections are attributed to Propionibacterium acnes, other species of Propionibacterium have been recovered from revision surgical sites 38 .…”

Relationship between annular tear and presence of Propionibacterium acnes in lumbar intervertebral disc

“…Some authors favor the view that P. acnes has already existed in the disc prior to surgery, which is associated with disc degeneration [2,6]. In contrast, the others propose that P. acnes in the disc tissue comes from bacterial contamination during surgery [7,8].…”

Multiplex Touchdown PCR for Rapid Typing of the Opportunistic Pathogen Propionibacterium acnes

“…Such data may prove especially valuable in our attempts to better understand the potential origin of different lineages associated with clinical samples, particularly in relation to blood culture, as well as whether the pattern of isolates recovered from primary surgical samples matches those on the overlying/surrounding skin, thus indicating potential contamination. In the surgical setting, the current methods used for preoperative skin antisepsis do not always prevent microbial contamination of surgical wounds with viable bacteria (52,53). Although acute surgical site infections may not ensue due to effective intravenous (i.v.)…”