Propionibacterium acnes: an agent of prosthetic joint infection and colonization

J Infect. 2007 Aug;55(2):119-24. doi: 10.1016/j.jinf.2007.02.006. Epub 2007 Apr 5.

Abstract

Background: Prosthetic joint infection (PJI) can present a diagnostic challenge, especially with slow-growing and poorly virulent bacteria.

Objective: To describe the epidemiological, clinical and biological characteristics of Propionibacterium acnes PJI, their treatments and outcomes and compare 2 clinical pictures (according to the time PJI symptoms appeared after the index operation: < or = 2 years, > 2 years).

Methods: We conducted a cohort study on P. acnes PJI. Diagnosis was based on > or = 2 positive cultures of intraoperative specimens taken during revision arthroplasties for infection or presumed aseptic loosening.

Results: Fifty patients with prosthetic hip (34), knee (10) or shoulder (6) infections were included and analyzed according to their symptom-free interval: < or = 2 years for 35 and > 2 years for 15 (mean interval: 11+/-6 years). The numbers of previous prostheses (p=0.04) were higher for the shorter-interval group, which had more frequent signs of infection (p=0.004). These findings suggest infection in most of the patients whose PJI symptoms appeared: < or = 2 years after the index operation, and colonization in the majority of those whose symptoms appeared > 2 years after index surgery. Treatment combining exchange arthroplasty with prolonged intravenous antibiotics was successful for 92% of the patients.

Conclusion: P. acnes can cause different types of PJI: late chronic infections, colonization of loosened prostheses and, exceptionally, acute postoperative infections.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Cohort Studies
  • Female
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / physiopathology
  • Gram-Positive Bacterial Infections / surgery*
  • Humans
  • Intraoperative Care
  • Joint Prosthesis / microbiology*
  • Male
  • Propionibacterium acnes / isolation & purification
  • Propionibacterium acnes / pathogenicity*
  • Reoperation
  • Risk Factors

Substances

  • Anti-Bacterial Agents