Archive for January 1, 2017

Postoperative Joint Infections Due to Propionibacterium Species: A Case-Control Study

Clinical Infectious Diseases 2009 V.49 N.7 P.1083-1085

Brief Report

Zeina A. Kanafani1, Daniel J. Sexton2, Brian C. Pien2, Jay Varkey2, Carl Basmania2, and Keith S. Kaye3

1American University of Beirut Medical Center, Beirut, Lebanon

2Duke University Medical Center, Durham, North Carolina

3Wayne State University/Detroit Medical Center, Detroit, Michigan

We compared 40 patients with Propionibacterium acnes postoperative joint infection to a cohort of uninfected patients. Infection manifested a median of 210 days after surgery. Most patients with joint prostheses underwent hardware removal. Prior joint surgery (odds ratio [OR], 28.2) and male sex (OR, 7.2) were independent risk factors for infection.



January 1, 2017 at 5:25 pm

Propionibacterium acnes Postoperative Shoulder Arthritis: An Emerging Clinical Entity

Clinical Infectious Diseases 2008 V.46 N.12 P.1884-1886

Brief Report

Pierre Yves Levy1,4, Florence Fenollar1, Andreas Stein2, Frederic Borrione4, Emile Cohen3, Bernhard Lebail4, and Didier Raoult1

1Unité des Rickettsies, Faculté de Médecine, Université de la Méditerranée, Clinique la Casamance, Aubagne, France

2Département de Maladies Infectieuses, Hôpital Universitaire Conception, and Clinique la Casamance, Aubagne, France

3Hôpital Ambroise Paré, Marseille, and Clinique la Casamance, Aubagne, France

4Clinique la Casamance, Aubagne, France

The purpose of this study, which involved 276 patients, was to report the importance of  Propionibacterium acnes in shoulder infections. The proportion of patients with shoulder infection who had infection due to P. acnes was significantly greater than the proportion of patients with lower limb infection who had infection due to P. acnes (9 of 16 patients vs. 1 of 233 patients; P<.001 ). This bacterium requires a prolonged incubation period and should not be considered to be a contaminant.


January 1, 2017 at 5:22 pm

Propionibacterium prosthetic joint infection: experience from a retrospective database analysis.

Eur J Orthop Surg Traumatol. 2016 May;26(4):429-34.

Rienmüller A1,2, Borens O3.

Author information

1Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland.

2Department of Orthopedic Surgery, Vienna General Hospital, Medical University Vienna, Waehriger Guertel 18-20, 1090, Vienna, Austria.

3Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland.



With improved diagnostic methods and longer prosthesis indwelling time, the frequency of diagnosed Propionibacterium prosthetic joint infections (PJI) is increasing. Data on clinical, microbiological, radiological and surgical treatment are limited, and importance of this organism in PJI is probably underestimated.


We retrospectively analyzed patients with PJI caused by Propionibacterium spp. diagnosed at our institution between 2000 and 2012. Patient data were retrieved through chart review, and the outcome was evaluated at patient follow-up visits.


Of 15 included patients (median age 65 years, range 44-87), 8 hip, 4 shoulder, 2 knee and 1 ankle PJI were recorded. The median time from implantation to diagnosis of PJI was 44.2 months (range 2-180 months). Most PJI (8 patients, 53 %) were diagnosed late (>24 months after arthroplasty). Persistent pain was present in 13, local joint symptoms in 8, fever in 4 and sinus tract in 3 patients. Radiological signs of loosening were present in 11 patients (73 %). Organisms were detected in intraoperative biopsy (n = 5), sonication (n = 4) or preoperative joint puncture (n = 4). In three cases coinfection with a coagulase-negative staphylococcus was diagnosed. Revision surgery was performed in all cases. After a mean follow-up of 16 months after revision surgery (range 4-37 months), 14 patients (93 %) showed no signs or symptoms of infection and had a functional prosthesis; one patient experienced a new infection with another organism (Staphylococcus epidermidis).


Patients with persistent postoperative pain and/or loosening of implants should be screened for PJI with low-virulent organisms such as Propionibacterium, including.


January 1, 2017 at 12:44 pm

Propionibacterium acnes infection after shoulder surgery.

Int J Shoulder Surg. 2015 Oct-Dec;9(4):139-44.

Kadler BK1, Mehta SS2, Funk L2.

Author information

1Faculty of Medicine and Human Sciences, University of Manchester, Manchester, UK.

2Upper Limb Unit, Wrightington Hospital, Appley Bridge, WN6 9EP, UK.


Propionibacterium acnes has been implicated as a cause of infection following shoulder surgery, may occur up to 2 years after the index operation and has been shown to be responsible for up to 56% of shoulder infections after orthopedic implant. Male patients within the population undergoing shoulder surgery are particularly at risk, especially if their shoulder surgery involved prosthesis or was posttraumatic. P. acnes infection can be difficult to diagnose clinically and laboratory techniques require prolonged and specialized cultures. Usual inflammatory markers are not raised in infection with this low virulence organism. Delayed diagnosis with P. acnes infection can result in significant morbidity prior to prosthesis failure. Early diagnosis of P. acnes infection and appropriate treatment can improve clinical outcomes. It is important to be aware of P. acnes infection in shoulder surgery, to evaluate risk factors, to recognize the signs of P. acnes infection, and to promptly initiate treatment. The signs and symptoms of P. acnes infection are described and discussed. Data were collected from PubMed™, Web of Science, and the NICE Evidence Healthcare Databases – AMED (Ovid), BNI (Ovid), CINAHL (EBSCO), Embase (Ovid), HMIC: DH-Data and Kings Fund (Ovid), Medline (Ovid), and PsycINFO (Ovid). The search terms used were “P. acnes,” “infection,” “shoulder,” and “surgery.” In this review, we summarize the current understanding of the prevention and management of P. acnes infection following shoulder surgery.


January 1, 2017 at 12:41 pm

Unexpected positive cultures including isolation of Propionibacterium acnes in revision shoulder arthroplasty.

Chin Med J (Engl). 2014;127(22):3975-9.

Kim SJ1, Kim JH2.

Author information

1Department of Orthopaedics, Korea Electric Power Corporation (KEPCO) Medical Foundation, KEPCO Medical center, Seoul, Republic of Korea.

2Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA.



Little information is available to guide treatment strategies regarding patients with unexpected positive cultures (UPC), including Propionibacterium acnes (PA), without overt signs of infection in revision shoulder arthroplasty (RSA). The purpose of our study was to analyze the prevalence, clinical meaning, treatment and prognosis of UPC in RSA.


We performed a systematic review of the literature between 1950 and 2013 for all studies reporting on UPC for PA. Studies with the prevalence and prognosis of patients with UPC in RSA were analyzed.


Six studies meeting our inclusion criteria yielded data for 1 402 patients who underwent a total of 1405 RSA. Based on the available data, following RSA 235 shoulders had UPCs with a pooled percentage of 16.7% (235/1405). The most commonly isolated bacteria from shoulders following RSA with UPCs was PA with pooled percentages of 63.4% (149/235). Occurrence of true infection from UPCs after RSA was seen in 24 shoulders (24/235, 10.2%). Antibiotic use did not influence the rate of the occurrence of true infection from UPCs (P = 0.498).


Our study showed a low risk of having a true infection from UPCs after RSA without clinical signs of preoperative infection at the time of the surgery. Therefore, prolonged antibiotic therapy may not be necessary in these patients.


January 1, 2017 at 12:39 pm

Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen.

Clin Microbiol Rev. 2014 Jul;27(3):419-40.

Achermann Y1, Goldstein EJ2, Coenye T3, Shirtliff ME4.

Author information

1Department of Microbial Pathogenesis, Dental School, University of Maryland, Baltimore, Maryland, USA.

2R. M. Alden Research Laboratory, Santa Monica, CA, USA, and David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

3Laboratorium voor Farmaceutische Microbiologie, Ghent University, Ghent, Belgium.

4Department of Microbial Pathogenesis, Dental School, University of Maryland, Baltimore, Maryland, USA Department of Microbiology and Immunology, School of Medicine, University of Maryland, Baltimore, Maryland, USA


Propionibacterium acnes is known primarily as a skin commensal. However, it can present as an opportunistic pathogen via bacterial seeding to cause invasive infections such as implant-associated infections. These infections have gained more attention due to improved diagnostic procedures, such as sonication of explanted foreign materials and prolonged cultivation time of up to 14 days for periprosthetic biopsy specimens, and improved molecular methods, such as broad-range 16S rRNA gene PCR. Implant-associated infections caused by P. acnes are most often described for shoulder prosthetic joint infections as well as cerebrovascular shunt infections, fibrosis of breast implants, and infections of cardiovascular devices. P. acnes causes disease through a number of virulence factors, such as biofilm formation. P. acnes is highly susceptible to a wide range of antibiotics, including beta-lactams, quinolones, clindamycin, and rifampin, although resistance to clindamycin is increasing. Treatment requires a combination of surgery and a prolonged antibiotic treatment regimen to successfully eliminate the remaining bacteria. Most authors suggest a course of 3 to 6 months of antibiotic treatment, including 2 to 6 weeks of intravenous treatment with a beta-lactam. While recently reported data showed a good efficacy of rifampin against P. acnes biofilms, prospective, randomized, controlled studies are needed to confirm evidence for combination treatment with rifampin, as has been performed for staphylococcal implant-associated infections.


January 1, 2017 at 12:36 pm


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