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Erschienen in: HSS Journal ® 2/2017

29.09.2016 | Original Article

Propionibacterium acnes Host Inflammatory Response During Periprosthetic Infection Is Joint Specific

verfasst von: Scott R. Nodzo, MD, K. Keely Boyle, MD, Samrath Bhimani, BS, Thomas R. Duquin, MD, Andy O. Miller, MD, Geoffrey H. Westrich, MD

Erschienen in: HSS Journal ® | Ausgabe 2/2017

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Abstract

Background

Propionibacterium acnes (P. acnes) has become increasingly recognized as a cause of periprosthetic joint infection (PJI).

Questions/Purposes

It is not currently known if the clinical presentation of P. acnes varies depending on the joint being infected.

Methods

We retrospectively reviewed patients infected with P. acnes after total hip, knee, and shoulder arthroplasty from two institutions. Patients were classified as having a PJI based on the Musculoskeletal Infection Society criteria and were excluded if they had a polymicrobial culture. Patient demographics, preoperative laboratory values, and microbiology data were analyzed.

Results

Eighteen knees, 12 hips, and 35 shoulders with a P. acnes PJI were identified. Median ESR was significantly higher in the knee (38.0 mm/h, IQR 18.0–58.0) and hip (33.5 mm/h, IQR 15.3–60.0) groups compared to the shoulder group (11.0 mm/h, IQR 4.5–30.5). C-reactive protein levels were higher in the knee (2.0 mg/dl, IQR 1.3–8.9) and hip (2.4 mg/dl, IQR 0.8–4.9) groups compared to the shoulder group (0.7 mg/dl, IQR 0.6–1.5). Median synovial fluid WBC was significantly higher in the knee group than shoulder group (19,950 cells/mm3, IQR 482–60,063 vs 750 cells/mm3, IQR 0–2825, respectively). Peripheral blood WBC levels were similar between groups, as was mean time of P. acnes growth in culture. Clindamycin resistance was present in all groups.

Conclusion

The manner in which a patient with P. acnes PJI presents is joint specific. Inflammatory markers were significantly higher in the knee and hip groups compared to the hip and shoulder groups, and long hold anaerobic cultures up to 14 days are necessary to accurately identify this organism.
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Literatur
1.
Zurück zum Zitat Achermann Y, Goldstein EJ, Coenye T, et al. Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev. 2014; 27(3): 419.CrossRefPubMedPubMedCentral Achermann Y, Goldstein EJ, Coenye T, et al. Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev. 2014; 27(3): 419.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Achermann Y, Tran B, Kang M, et al. Immunoproteomic identification of in vivo-produced propionibacterium acnes proteins in a rabbit biofilm infection model. Clin Vaccine Immunol. 2015; 22(5): 467.CrossRefPubMedPubMedCentral Achermann Y, Tran B, Kang M, et al. Immunoproteomic identification of in vivo-produced propionibacterium acnes proteins in a rabbit biofilm infection model. Clin Vaccine Immunol. 2015; 22(5): 467.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Blomgren G, Lundquist H, Nord CE, et al. Late anaerobic haematogenous infection of experimental total joint replacement. A study in the rabbit using Propionibacterium acnes. J Bone Joint Surg Br. 1981; 63B(4): 614.PubMed Blomgren G, Lundquist H, Nord CE, et al. Late anaerobic haematogenous infection of experimental total joint replacement. A study in the rabbit using Propionibacterium acnes. J Bone Joint Surg Br. 1981; 63B(4): 614.PubMed
4.
Zurück zum Zitat Bruggemann H. Insights in the pathogenic potential of Propionibacterium acnes from its complete genome. Semin Cutan Med Surg. 2005; 24(2): 67.CrossRefPubMed Bruggemann H. Insights in the pathogenic potential of Propionibacterium acnes from its complete genome. Semin Cutan Med Surg. 2005; 24(2): 67.CrossRefPubMed
5.
Zurück zum Zitat Bruggemann H, Henne A, Hoster F, et al. The complete genome sequence of Propionibacterium acnes, a commensal of human skin. Science. 2004; 305(5684): 671.CrossRefPubMed Bruggemann H, Henne A, Hoster F, et al. The complete genome sequence of Propionibacterium acnes, a commensal of human skin. Science. 2004; 305(5684): 671.CrossRefPubMed
6.
Zurück zum Zitat Butler-Wu SM, Burns EM, Pottinger PS, et al. Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol. 2011; 49(7): 2490.CrossRefPubMedPubMedCentral Butler-Wu SM, Burns EM, Pottinger PS, et al. Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol. 2011; 49(7): 2490.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Crane JK, Hohman DW, Nodzo SR, et al. Antimicrobial susceptibility of Propionibacterium acnes isolates from shoulder surgery. Antimicrob Agents Chemother. 2013; 57(7): 3424.CrossRefPubMedPubMedCentral Crane JK, Hohman DW, Nodzo SR, et al. Antimicrobial susceptibility of Propionibacterium acnes isolates from shoulder surgery. Antimicrob Agents Chemother. 2013; 57(7): 3424.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Dodson CC, Craig EV, Cordasco FA, et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg. 2010; 19(2): 303.CrossRefPubMed Dodson CC, Craig EV, Cordasco FA, et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg. 2010; 19(2): 303.CrossRefPubMed
9.
Zurück zum Zitat Fitz-Gibbon S, Tomida S, Chiu BH, et al. Propionibacterium acnes strain populations in the human skin microbiome associated with acne. J Invest Dermatol. 2013; 133(9): 2152.CrossRefPubMedPubMedCentral Fitz-Gibbon S, Tomida S, Chiu BH, et al. Propionibacterium acnes strain populations in the human skin microbiome associated with acne. J Invest Dermatol. 2013; 133(9): 2152.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Frangiamore SJ, Saleh A, Kovac MF, et al. Synovial fluid interleukin-6 as a predictor of periprosthetic shoulder infection. J Bone Joint Surg Am. 2015; 97(1): 63.CrossRefPubMed Frangiamore SJ, Saleh A, Kovac MF, et al. Synovial fluid interleukin-6 as a predictor of periprosthetic shoulder infection. J Bone Joint Surg Am. 2015; 97(1): 63.CrossRefPubMed
11.
Zurück zum Zitat Furustrand Tafin U, Corvec S, Betrisey B, et al. Role of rifampin against Propionibacterium acnes biofilm in vitro and in an experimental foreign-body infection model. Antimicrob Agents Chemother. 2012; 56(4): 1885.CrossRefPubMedPubMedCentral Furustrand Tafin U, Corvec S, Betrisey B, et al. Role of rifampin against Propionibacterium acnes biofilm in vitro and in an experimental foreign-body infection model. Antimicrob Agents Chemother. 2012; 56(4): 1885.CrossRefPubMedPubMedCentral
12.
13.
Zurück zum Zitat Holmberg A, Lood R, Morgelin M, et al. Biofilm formation by Propionibacterium acnes is a characteristic of invasive isolates. Clin Microbiol Infect. 2009; 15(8): 787.CrossRefPubMed Holmberg A, Lood R, Morgelin M, et al. Biofilm formation by Propionibacterium acnes is a characteristic of invasive isolates. Clin Microbiol Infect. 2009; 15(8): 787.CrossRefPubMed
14.
Zurück zum Zitat Johnston DH, Fairclough JA, Brown EM, et al. Rate of bacterial recolonization of the skin after preparation: four methods compared. Br J Surg. 1987; 74(1): 64.CrossRefPubMed Johnston DH, Fairclough JA, Brown EM, et al. Rate of bacterial recolonization of the skin after preparation: four methods compared. Br J Surg. 1987; 74(1): 64.CrossRefPubMed
15.
Zurück zum Zitat Khassebaf J, Hellmark B, Davidsson S, et al. Antibiotic susceptibility of Propionibacterium acnes isolated from orthopaedic implant-associated infections. Anaerobe. 2015; 32: 57.CrossRefPubMed Khassebaf J, Hellmark B, Davidsson S, et al. Antibiotic susceptibility of Propionibacterium acnes isolated from orthopaedic implant-associated infections. Anaerobe. 2015; 32: 57.CrossRefPubMed
16.
Zurück zum Zitat Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol. 2002; 169(3): 1535.CrossRefPubMedPubMedCentral Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol. 2002; 169(3): 1535.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Kurtz SM, Ong KL, Schmier J, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am. 2007; 89(Suppl 3): 144.PubMed Kurtz SM, Ong KL, Schmier J, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am. 2007; 89(Suppl 3): 144.PubMed
18.
Zurück zum Zitat McDowell A, Gao A, Barnard E, et al. A novel multilocus sequence typing scheme for the opportunistic pathogen Propionibacterium acnes and characterization of type I cell surface-associated antigens. Microbiology. 2011; 157(Pt 7): 1990.CrossRefPubMed McDowell A, Gao A, Barnard E, et al. A novel multilocus sequence typing scheme for the opportunistic pathogen Propionibacterium acnes and characterization of type I cell surface-associated antigens. Microbiology. 2011; 157(Pt 7): 1990.CrossRefPubMed
19.
Zurück zum Zitat McDowell A, Hunyadkurti J, Horvath B, et al. Draft genome sequence of an antibiotic-resistant Propionibacterium acnes strain, PRP-38, from the novel type IC cluster. J Bacteriol. 2012; 194(12): 3260.CrossRefPubMedPubMedCentral McDowell A, Hunyadkurti J, Horvath B, et al. Draft genome sequence of an antibiotic-resistant Propionibacterium acnes strain, PRP-38, from the novel type IC cluster. J Bacteriol. 2012; 194(12): 3260.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat McDowell A, Perry AL, Lambert PA, et al. A new phylogenetic group of Propionibacterium acnes. J Med Microbiol. 2008; 57(Pt 2): 218.CrossRefPubMed McDowell A, Perry AL, Lambert PA, et al. A new phylogenetic group of Propionibacterium acnes. J Med Microbiol. 2008; 57(Pt 2): 218.CrossRefPubMed
21.
Zurück zum Zitat Nakatsuji T, Tang DC, Zhang L, et al. Propionibacterium acnes CAMP factor and host acid sphingomyelinase contribute to bacterial virulence: potential targets for inflammatory acne treatment. PLoS One. 2011; 6(4): e14797.CrossRefPubMedPubMedCentral Nakatsuji T, Tang DC, Zhang L, et al. Propionibacterium acnes CAMP factor and host acid sphingomyelinase contribute to bacterial virulence: potential targets for inflammatory acne treatment. PLoS One. 2011; 6(4): e14797.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Nodzo SR, Hohman DW, Crane JK, et al. Hemolysis as a clinical marker for propionibacterium acnes orthopedic infection. Am J Orthop (Belle Mead NJ). 2014; 43(5): E93. Nodzo SR, Hohman DW, Crane JK, et al. Hemolysis as a clinical marker for propionibacterium acnes orthopedic infection. Am J Orthop (Belle Mead NJ). 2014; 43(5): E93.
23.
Zurück zum Zitat Parvizi J. New definition for periprosthetic joint infection. Am J Orthop (Belle Mead NJ). 2011; 40(12): 614. Parvizi J. New definition for periprosthetic joint infection. Am J Orthop (Belle Mead NJ). 2011; 40(12): 614.
24.
Zurück zum Zitat Pottinger P, Butler-Wu S, Neradilek MB, et al. Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening. J Bone Joint Surg Am. 2012; 94(22): 2075.CrossRefPubMed Pottinger P, Butler-Wu S, Neradilek MB, et al. Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening. J Bone Joint Surg Am. 2012; 94(22): 2075.CrossRefPubMed
25.
Zurück zum Zitat Ramage G, Tunney MM, Patrick S, et al. Formation of Propionibacterium acnes biofilms on orthopaedic biomaterials and their susceptibility to antimicrobials. Biomaterials. 2003; 24(19): 3221.CrossRefPubMed Ramage G, Tunney MM, Patrick S, et al. Formation of Propionibacterium acnes biofilms on orthopaedic biomaterials and their susceptibility to antimicrobials. Biomaterials. 2003; 24(19): 3221.CrossRefPubMed
26.
Zurück zum Zitat Sampedro MF, Piper KE, McDowell A, et al. Species of Propionibacterium and Propionibacterium acnes phylotypes associated with orthopedic implants. Diagn Microbiol Infect Dis. 2009; 64(2): 138.CrossRefPubMed Sampedro MF, Piper KE, McDowell A, et al. Species of Propionibacterium and Propionibacterium acnes phylotypes associated with orthopedic implants. Diagn Microbiol Infect Dis. 2009; 64(2): 138.CrossRefPubMed
27.
Zurück zum Zitat Singh JA, Sperling JW, Schleck C, et al. Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. J Shoulder Elbow Surg. 2012; 21(11): 1534.CrossRefPubMedPubMedCentral Singh JA, Sperling JW, Schleck C, et al. Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. J Shoulder Elbow Surg. 2012; 21(11): 1534.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Tunney MM, Patrick S, Gorman SP, et al. Improved detection of infection in hip replacements. A currently underestimated problem. J Bone Joint Surg Br. 1998; 80(4): 568.CrossRefPubMed Tunney MM, Patrick S, Gorman SP, et al. Improved detection of infection in hip replacements. A currently underestimated problem. J Bone Joint Surg Br. 1998; 80(4): 568.CrossRefPubMed
29.
Zurück zum Zitat Tunney MM, Ramage G, Patrick S, et al. Antimicrobial susceptibility of bacteria isolated from orthopedic implants following revision hip surgery. Antimicrob Agents Chemother. 1998; 42(11): 3002.PubMedPubMedCentral Tunney MM, Ramage G, Patrick S, et al. Antimicrobial susceptibility of bacteria isolated from orthopedic implants following revision hip surgery. Antimicrob Agents Chemother. 1998; 42(11): 3002.PubMedPubMedCentral
30.
Zurück zum Zitat Zeller V, Ghorbani A, Strady C, et al. Propionibacterium acnes: an agent of prosthetic joint infection and colonization. J Infect. 2007; 55(2): 119.CrossRefPubMed Zeller V, Ghorbani A, Strady C, et al. Propionibacterium acnes: an agent of prosthetic joint infection and colonization. J Infect. 2007; 55(2): 119.CrossRefPubMed
Metadaten
Titel
Propionibacterium acnes Host Inflammatory Response During Periprosthetic Infection Is Joint Specific
verfasst von
Scott R. Nodzo, MD
K. Keely Boyle, MD
Samrath Bhimani, BS
Thomas R. Duquin, MD
Andy O. Miller, MD
Geoffrey H. Westrich, MD
Publikationsdatum
29.09.2016
Verlag
Springer US
Erschienen in
HSS Journal ® / Ausgabe 2/2017
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-016-9528-2

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