Propionobacter acnes Infection as an Occult Cause of Postoperative Shoulder Pain: A Case Series

Millett, Peter J.; Yen, Yi‐Meng; Price, Connie S.; Meijden, Olivier A. van der; Elser, Florian

doi:10.1007/s11999-011-1767-4

Cited by 110 publications

(75 citation statements)

References 41 publications

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“…In most reports, clindamycin and vancomycin are mentioned as the first drugs to consider for deepseated P. acnes infections (15). Our data, like those in the study by Oprica et al (11), suggest that penicillins and first-generation cephalosporins (cefazolin and cephalothin) show promise and should have an expanded role in studies of clinical efficacy.…”

supporting

confidence: 73%

Antimicrobial Susceptibility of Propionibacterium acnes Isolates from Shoulder Surgery

Crane

Hohman

Nodzo

et al. 2013

Antimicrob Agents Chemother

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c Orthopedic surgeons at our institution have noticed an increase in the number of infections due to Propionibacterium acnes, especially following operations on the shoulder. We collected P. acnes isolates from our hospital microbiology laboratory for 1 year and performed antimicrobial susceptibility testing on 28 strains from the shoulder. Antibiotics with the lowest MIC values against P. acnes (MIC 50 and MIC 90 ) included penicillin G (0.006, 0.125), cephalothin (0.047 and 0.094), and ceftriaxone (0.016, 0.045), while others also showed activity. Strains resistant to clindamycin were noted. Propionibacterium acnes has been recognized as a significant and emerging pathogen in orthopedic surgery over the last 10 years, especially after operations on the shoulder and especially following shoulder arthroplasty with prosthetic material (1-3). At our institution, the number of recognized cases of P. acnes has increased noticeably over the last few years. Formulating treatment recommendations for patients with P. acnes orthopedic infections can be difficult, however, given the paucity of data on antibiotic susceptibility patterns. Many of the early reports on P. acnes antibiotic susceptibilities are from patients with facial acne who were attending dermatology clinics. Other studies are now decades old (4, 5) or originate from countries in which antibiotic usage patterns are much different from those in North America (6, 7), leading us to question whether we can rely on those reports.We performed testing on 33 strains of P. acnes collected between November 2010 and December 2012, 28 of which were from orthopedic surgeries on the shoulder and 5 of which were isolates from bloodstream or other deep infections. P. acnes was identified using the MicroScan rapid anaerobe identification method (Siemens Healthcare, W. Sacramento, CA). We tested this strain collection against a panel of 10 antibiotics, with an emphasis on antibiotics that might actually be used to treat postoperative orthopedic infections. We used the Etest method (bioMérieux, Durham, NC) on anaerobic brucella blood agar. Two previous studies indicated that MICs obtained by Etest correlated well with results obtained using the agar dilution method (8, 9), and other experts consider the Etest an accepted method (10). Etest results obtained using anaerobic brucella blood agar were compared to those obtained using CDC anaerobe blood agar on a subset of 6 strains. Inocula were prepared to a 0.5 McFarland standard from 48 h of growth on anaerobic blood agar. Blood agars were from Anaerobe Systems (Morgan Hill, CA). We tested only a single isolate from each patient, although most patients had more than one positive culture. P. acnes was cultured anaerobically at 37°C for 48 to 72 h using the GasPak EZ anaerobe container system (BD Corp., Franklin Lakes, NJ).The results of our study are reported in Table 1. MICs measured on brucella blood agar were the same as those measured using CDC anaerobe agar. The penicillins (penicillin G and amoxicillin) and cephalosporins...

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supporting

confidence: 73%

Antimicrobial Susceptibility of Propionibacterium acnes Isolates from Shoulder Surgery

Crane

Hohman

Nodzo

et al. 2013

Antimicrob Agents Chemother

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“…In only 2 patients (4.1 %) out of the entire study population no predisposing factors were identified (the patients with infection of the talocrural joint and thoracic empyema), suggesting that these infections might have occurred spontaneously. This observation is in keeping with the marked predominance of reports describing invasive P. acnes infections following neurosurgical and orthopaedic operations in the literature, and the paucity of publications reporting cases with no apparent risk factors [11][12][13][14][15][16][17][18][19][20][21][22][25][26][27].…”

Section: Discussionsupporting

confidence: 80%

“…Few studies have attempted to capture the full spectrum of P. acnes-related infections in a non-selective patient cohort [8,9]. In addition, in most previous studies, P. acnes infections were not the primary focus, and the vast majority of previous reports included fewer than 20 cases of invasive P. acnes infection [11,14,[18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome

Tebruegge

Jones

Sukhtankar

et al. 2014

Eur J Clin Microbiol Infect Dis

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An increasing number of reports suggest that Propionibacterium acnes can cause serious invasive infections. Currently, only limited data exist regarding the spectrum of invasive P. acnes infections. We conducted a non-selective cohort study at a tertiary hospital in the UK over a 9-year-period (2003-2012) investigating clinical manifestations, risk factors, management, and outcome of invasive P. acnes infections. Forty-nine cases were identified; the majority were neurosurgical infections and orthopaedic infections (n = 28 and n = 15 respectively). Only 2 cases had no predisposing factors; all neurosurgical and 93.3 % of orthopaedic cases had a history of previous surgery and/or trauma. Foreign material was in situ at the infection site in 59.3 % and 80.0 % of neurosurgical and orthopaedic cases respectively. All neurosurgical and orthopaedic cases required one or more surgical interventions to treat P. acnes infection, with or without concomitant antibiotic therapy; the duration of antibiotic therapy was significantly longer in the group of orthopaedic cases (median 53 vs 19 days; p = 0.0025). All tested P. acnes isolates were susceptible to penicillin, ampicillin and chloramphenicol; only 1 was clindamycin-resistant. Neurosurgical and orthopaedic infections account for the majority of invasive P. acnes infections. Most cases have predisposing factors, including previous surgery and/or trauma; spontaneous infections are rare. Foreign material is commonly present at the site of infection, indicating that the pathogenesis of invasive P. acnes infections likely involves biofilm formation. Since invasive P. acnes infections are associated with considerable morbidity, further studies are needed to establish effective prevention and optimal treatment strategies.

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“…With P. acnes and, at times, Actinomyces species, infection may be more indolent, leading to normal sedimentation rate and/or C-reactive protein [16,17]. In one study only 10% of patients with P. acnes shoulder arthroplasty infection had an elevated sedimentation rate or C-reactive protein [18].…”

Section: Diagnostic Methodsmentioning

confidence: 99%

Anaerobic prosthetic joint infection

et al. 2015

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Propionobacter acnes Infection as an Occult Cause of Postoperative Shoulder Pain: A Case Series

Cited by 110 publications

References 41 publications

Antimicrobial Susceptibility of Propionibacterium acnes Isolates from Shoulder Surgery

Antimicrobial Susceptibility of Propionibacterium acnes Isolates from Shoulder Surgery

Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome

Anaerobic prosthetic joint infection

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