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Yadav AK, Bhooshan S, Johnson A, Asati DP, Nema S, Biswas D. Association of Antimicrobial Susceptibility and Treatment Outcome in Acne Vulgaris Patients: A Pilot Study. J Lab Physicians 2021; 12:233-238. [PMID: 33469248 PMCID: PMC7808859 DOI: 10.1055/s-0040-1720943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose
Cutibacterium acnes
(
C. acnes
) is an emerging pathogen that is highly resistant to antibiotics and is capable of causing persistent infections that are difficult to treat.
Methods & Materials
Acne vulgaris patients visiting dermatology OPD of our tertiary care hospital during the study period of 2 months were recruited. Skin swabs were collected, and the sample was processed on 5% sheep-blood agar for anaerobic culture by the GasPak method. Isolates were identified by the standard biochemical test. Antimicrobial susceptibility testing was performed for clinically relevant antibiotics by the E-strip method. The clinical response was evaluated after 1-month follow-up to the prescribed antibiotics.
Results
Minocycline, doxycycline, ceftriaxone, and tetracycline were the most effective antibiotics. Nonsusceptibility to clindamycin and erythromycin were observed in 11.9% and 31% isolates, respectively, with 9.5% isolates being nonsusceptible to both. For none of the antibiotics we found significant difference in the proportion of susceptible and nonsusceptible isolates between mild, moderate, and severe grades of acne vulgaris. For none of the antibiotic regimens, significant difference was observed between nonresponders and responders. Twenty-seven patients received clindamycin and among them 16 of 19 responders and 6 of 8 nonresponders yielded growth of clindamycin-susceptible isolates (
p
= 0.57).
Conclusion
We observed significant prevalence of resistant strains of
C. acnes
among patients with acne vulgaris. No association was observed between in vitro susceptibility results and treatment outcome.
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Affiliation(s)
- Ashvini K Yadav
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Suneel Bhooshan
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Allen Johnson
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Dinesh P Asati
- Department of Dermatology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Shashwati Nema
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Debasis Biswas
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
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2
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Salle H, Deluche E, Couvé-Deacon E, Beaujeux AC, Pallud J, Roux A, Dagain A, de Barros A, Voirin J, Seizeur R, Belmabrouk H, Lemnos L, Emery E, Fotso MJ, Engelhardt J, Jecko V, Zemmoura I, Le Van T, Berhouma M, Cebula H, Peyre M, Preux PM, Caire F. Surgical Site Infections after glioblastoma surgery: results of a multicentric retrospective study. Infection 2020; 49:267-275. [PMID: 33034890 DOI: 10.1007/s15010-020-01534-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effects of surgical site infections (SSI) after glioblastoma surgery on patient outcomes are understudied. The aim of this retrospective multicenter study was to evaluate the impact of SSI on the survival of glioblastoma patients. METHODS Data from SSI cases after glioblastoma surgeries between 2009 and 2016 were collected from 14 French neurosurgical centers. Collected data included patient demographics, previous medical history, risk factors, details of the surgical procedure, radiotherapy/chemotherapy, infection characteristics, and infection management. Similar data were collected from gender- and age-paired control individuals. RESULTS We used the medical records of 77 SSI patients and 58 control individuals. 13 were excluded. Our analyses included data from 64 SSI cases and 58 non-infected glioblastoma patients. Infections occurred after surgery for primary tumors in 38 cases (group I) and after surgery for a recurrent tumor in 26 cases (group II). Median survival was 381, 633, and 547 days in patients of group I, group II, and the control group, respectively. Patients in group I had significantly shorter survival compared to the other two groups (p < 0.05). The one-year survival rate of patients who developed infections after surgery for primary tumors was 50%. Additionally, we found that SSIs led to postoperative treatment discontinuation in 30% of the patients. DISCUSSION Our findings highlighted the severity of SSIs after glioblastoma surgery, as they significantly affect patient survival. The establishment of preventive measures, as well as guidelines for the management of SSIs, is of high clinical importance.
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Affiliation(s)
- Henri Salle
- Neurochirurgie, CHU de Limoges, Limoges, France. .,CAPTuR, EA 3842, Université de Limoges, Limoges, France.
| | | | | | | | - Johan Pallud
- Neurochirurgie, GHU Paris - Hôpital Sainte-Anne, Paris, France.,IMA-BRAIN, UMR1266, Inserm, Paris, France
| | - Alexandre Roux
- Neurochirurgie, GHU Paris - Hôpital Sainte-Anne, Paris, France.,IMA-BRAIN, UMR1266, Inserm, Paris, France
| | - Arnaud Dagain
- Neurochirurgie, BCRM Toulon, HIA Sainte-Anne, Toulon, France
| | - Amaury de Barros
- Neurochirurgie, CHU de Toulouse, Hopital Pierre-Paul Riquet, Toulouse, France
| | - Jimmy Voirin
- Neurochirurgie, Hôpitaux Civils de Colmar, Colmar, France.,Neurochirurgie, CHU de Strasbourg, Strasbourg, France
| | - Romuald Seizeur
- Neurochirurgie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France.,Université de BREST, LaTIM INSERM UMR 1101, Brest, France
| | - Houda Belmabrouk
- Neurochirurgie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
| | | | - Evelyne Emery
- Neurochirurgie, CHU Caen Normandie, Caen, France.,Université CAEN Normandie, Inserm U 12 37, Cycéron, Caen, France
| | | | | | - Vincent Jecko
- Neurochirurgie, CHU de Bordeaux, Bordeaux, France.,INCIA, UMR 5287, Université de Bordeaux, CNRS, Bordeaux, France
| | - Ilyess Zemmoura
- Neurochirurgie, CHU de Tours, Tours, France.,iBrain, UMR 1253, Université de Tours, Inserm, Tours, France
| | | | - Moncef Berhouma
- Neurochirurgie, CHU de Lyon, Hôpital Neurologique Pierre Wertheimer, Lyon, France.,Creatis Laboratory, , CNRS UMR 5220, INSERM U1206, Université Lyon 1/INSA, Lyon, France
| | - Hélène Cebula
- Neurochirurgie, CHU de Strasbourg, Strasbourg, France
| | - Matthieu Peyre
- Neurochirurgie, APHP, Groupe Hospitalier Pitié Salpêtrière, Paris, France.,Genetics and Development of Brain Tumors - CRICM INSERM U1127 CNRS UMR 7225, Paris, France
| | - Pierre-Marie Preux
- Centre d'Epidémiologie, CHU de Limoges, de Biostatistiques Et de Méthodologie de La Recherche CEBIMER, Limoges, France
| | - François Caire
- Neurochirurgie, CHU de Limoges, Limoges, France.,XLIM, UMR 7252, Université de Limoges, CNRS, Limoges, France
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3
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Risk Factors and Outcomes of Cutibacterium acnes Postoperative Central Nervous System Infection: A Case-Control Study. World Neurosurg 2020; 137:e251-e256. [PMID: 32004741 DOI: 10.1016/j.wneu.2020.01.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Cutibacterium acnes has emerged as a significant cause of postoperative central nervous system infections (PCNSIs). We sought to determine risk factors and outcomes associated with C. acnes PCNSI. METHODS This was a single-center 1:1 case-control study of patients with monobacterial C. acnes-associated PCNSI (cases) and unmatched controls with PCNSI caused by aerobic organisms. Patient and procedure-related characteristics were compared between groups. The main outcome was cure at 90 days after diagnosis. Mortality and neurologic disability were secondary outcomes. RESULTS We identified 13 patients with C. acnes PCNSI and 13 controls. All patients had postoperative intracranial abscess. Onset of infection was significantly later for cases versus controls (median and range, 22 [19-116] days and 15 [1-27] days, respectively; P = 0.002). Prolonged anaerobic incubation was required for C. acnes isolation (median, 8 days vs. 2 days for aerobic pathogens; P < 0.0001). The use of sealant and implants, fever at presentation, and white blood cell and C-reactive protein levels were similar between the 2 groups. All patients underwent surgical drainage. Patients received a median of 4 antibiotic drugs and 85 antibiotic days of treatment, with no significant between-group differences. Cure at 90 days was achieved for 10 patients (76.9%) with C. acnes PCNSI and 11 (84.6%) controls (P = 1.0). CONCLUSIONS C. acnes PCNSI presents later than infection with aerobic bacteria but is associated with similar risk factors and clinical outcomes. These results underscore the importance of prolonged anaerobic incubation to optimize the recovery of C. acnes in the laboratory.
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Pietropaoli C, Cavalli Z, Jouanneau E, Tristan A, Conrad A, Ader F, Guyotat J, Chidiac C, Ferry T. Cerebral empyema and abscesses due to Cutibacterium acnes. Med Mal Infect 2019; 50:274-279. [PMID: 31668987 DOI: 10.1016/j.medmal.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 09/18/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Cutibacterium acnes is a commensal bacterium of the skin, frequently reported in prosthetic shoulder or spinal implant infections, but rarely in cranial and intracranial infections. METHODS We retrospectively reviewed patients with intracranial samples positive to Cutibacterium acnes managed in the neurosurgical units of our hospital of Lyon, France, between 2008-2016. RESULTS We included 29 patients, of whom 23 had empyema (with or without abscess), 17 had cranial osteomyelitis, and six only had abscess. Prior neurosurgery was reported in 28 patients, and the remaining patient had four spontaneous abscesses. Twelve patients had polymicrobial infections, including methicillin-susceptible Staphylococcus in 11 cases. The clinical diagnosis was difficult because of indolent and delayed symptoms: a CT scan or MRI was required. Thirteen patients (52%) had material at the infection site. All patients with bone flap implant or bones from biological banks had a bone flap-associated infection. Drainage was surgically performed in 25 cases or by CT scan-guided aspiration in four cases. All patients received an adapted antibiotic therapy (from three weeks to six months). The outcome was favorable in 28 patients. Three patients relapsed during the antibiotic therapy, requiring further surgery. CONCLUSION Cutibacterium acnes can be responsible for postoperative empyema and cerebral abscesses, with particular indolent forms, which make their diagnosis difficult. They are often polymicrobial and associated with bone flap osteomyelitis. Their outcome is favorable after drainage and adapted antibiotic therapy.
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Affiliation(s)
- C Pietropaoli
- Department of Internal Medecine and Infectious Diseases, Hospital Center of Villefranche sur Saône, Hôpital Nord-Ouest, 39, plateau d'Ouilly-Gleizé, 69655 Villefranche-sur-Saône, France.
| | - Z Cavalli
- Department of Internal Medecine, Regional Hospital Center of Metz-Thionville, Metz, France
| | - E Jouanneau
- Department of Neurosurgery, hospices civils de Lyon, Lyon University Hospital, Bron, France
| | - A Tristan
- Department of Bacteriology, hospices civils de Lyon, Lyon University Hospital, Lyon, France
| | - A Conrad
- Department of Infectious Diseases, hospices civils de Lyon, Lyon University Hospital, Lyon, France
| | - F Ader
- Department of Infectious Diseases, hospices civils de Lyon, Lyon University Hospital, Lyon, France
| | - J Guyotat
- Department of Neurosurgery, hospices civils de Lyon, Lyon University Hospital, Bron, France
| | - C Chidiac
- Department of Infectious Diseases, hospices civils de Lyon, Lyon University Hospital, Lyon, France
| | - T Ferry
- Department of Infectious Diseases, hospices civils de Lyon, Lyon University Hospital, Lyon, France
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5
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Mortazavi MM, Khan MA, Quadri SA, Suriya SS, Fahimdanesh KM, Fard SA, Hassanzadeh T, Taqi MA, Grossman H, Tubbs RS. Cranial Osteomyelitis: A Comprehensive Review of Modern Therapies. World Neurosurg 2018; 111:142-153. [DOI: 10.1016/j.wneu.2017.12.066] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
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6
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McKerr C, Coetzee N, Edeghere O, Suleman S, Verlander N, Banavathi K. Association between post-craniotomy Propionibacterium acnes infection and dural implants: a case–control study. J Hosp Infect 2017; 97:389-396. [DOI: 10.1016/j.jhin.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
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7
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González P, Thenier J, Galárraga R, de la Lama A, Azevedo E, Conde C. Persistent extra-axial post-surgical collections and Propionibacterium acnes infection. Presentation of two cases and literature review. Neurocirugia (Astur) 2017; 29:150-156. [PMID: 29033263 DOI: 10.1016/j.neucir.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/22/2017] [Accepted: 09/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES It is common to observe the persistence of extra-axial collections after craniotomies. Most of these disappear in weeks or months but some remain. The onset of focal symptoms or the growth of these persistent collections months or years after surgery may indicate the presence of a chronic and latent infection by germs of low virulence such as Propionibacterium acnes (P. acnes). METHODS We present two clinical cases with persistent extra-axial collections, which required surgery years after diagnosis, in which P. acnes was isolated as an aetiological agent and we reviewed the literature published in this regard. RESULTS These are two patients who, following surgical procedures (decompressive craniectomy for severe TBI and craniotomy for right parietal meningioma) and extra-axial collections were kept, which were monitored over time and then were infected and required emergency evacuation. In these collections P. acnes grew as a causal agent and required targeted antibiotics. CONCLUSIONS We must consider P. acnes as an infectious agent of post-surgical collections of long evolution. Atypical presentation and radiological changes may be helpful in diagnosis.
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Affiliation(s)
- Pedro González
- Servicio de Neurocirugía, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Pontevedra, España.
| | - José Thenier
- Servicio de Neurocirugía, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Pontevedra, España
| | - Raúl Galárraga
- Servicio de Neurocirugía, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Pontevedra, España
| | - Adolfo de la Lama
- Servicio de Neurocirugía, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Pontevedra, España
| | - Eva Azevedo
- Servicio de Neurocirugía, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Pontevedra, España
| | - Cesáreo Conde
- Servicio de Neurocirugía, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Pontevedra, España
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8
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Yakhkind A, Yacoub HA, Grove J, Varrato JD, Castaldo JE. Pathogenesis, clinical course and neuro-radiological signs of Proprionibacterium acnes cerebritis: Case report and literature review. Hosp Pract (1995) 2015; 43:128-36. [PMID: 25762004 DOI: 10.1080/21548331.2015.1017438] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The clinical and neuroimaging characteristics of brain infections related to Propionibacterium acnes are not well-characterized, making early diagnosis and treatment a challenge. More recently, life-threatening central nervous system infections with P. acnes are being reported with increasing frequency as complications of neurointerventional procedures. We present a rare case of P. acnes cerebritis that occurred as a sequela of bare platinum aneurysm coiling and a contaminant of percutaneous angiographic intervention. We include an extensive review of the literature describing the pathogenesis of P. acnes and neuro-radiological signs of brain infections related to this pathogen.
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Affiliation(s)
- Aleksandra Yakhkind
- University of South Florida Morsani College of Medicine - SELECT Program , Allentown, PA , USA
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9
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Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome. Eur J Clin Microbiol Infect Dis 2014; 34:527-34. [DOI: 10.1007/s10096-014-2256-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
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10
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Walter G, Vernier M, Pinelli PO, Million M, Coulange M, Seng P, Stein A. Bone and joint infections due to anaerobic bacteria: an analysis of 61 cases and review of the literature. Eur J Clin Microbiol Infect Dis 2014; 33:1355-64. [DOI: 10.1007/s10096-014-2073-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
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11
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Microbial contamination assessment of cryostored autogenous cranial bone flaps: should bone biopsies or swabs be performed? Acta Neurochir (Wien) 2013; 155:367-71. [PMID: 23053290 DOI: 10.1007/s00701-012-1517-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Autogenous cranioplasty infection requiring bone flap removal is under-recognised as a major complication causing significant morbidity. Microbial contamination of stored bone flaps may be a significant contributing factor. Current infection control practices and storage procedures vary. It is not known whether 'superficial' swabs or bone cultures provide a more accurate assessment. METHOD Twenty-five skull flaps that were cryo-stored for more than 6 months were studied. Two swab samples (superficial and deep) and a bone biopsy sample were taken from each skull flap sample and cultured. Half blood agar and half chocolate agar plates were inoculated with the swabs for anaerobic and aerobic cultures respectively. The bone biopsy samples were cultured in brain-heart broth and subcultured similar to the swabs for 5 days. RESULTS Incidence of microbial contamination was 20 % in the bone flaps studied. One swab culture and five bone biopsy cultures were positive for bacterial growth, all of which contained Propionibacterium acnes (p = 0.014). Positive cultures were from bone flaps stored less than 18 months, whereas no growth was obtained from bone flaps that were stored longer (p = 0.014). CONCLUSIONS Bone biopsy culture is a more sensitive technique of assessing microbial contamination of cryo-stored autogenous bone flaps than swab cultures. The clinical implications of in vitro demonstration of microbial contamination require further study.
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Marbacher S, Andereggen L, Erhardt S, Fathi AR, Fandino J, Raabe A, Beck J. Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty. Neurosurg Rev 2012; 35:527-35; discussion 535. [DOI: 10.1007/s10143-012-0376-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 09/05/2011] [Accepted: 11/20/2011] [Indexed: 10/28/2022]
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13
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Levitt MR, Gabikian P, Pottinger PS, Silbergeld DL. Propionibacterium acnes Osteomyelitis Occurring 23 Years After Craniotomy: Case Report and Review of Literature. Neurosurgery 2011; 69:E773-9; discussion E779. [DOI: 10.1227/neu.0b013e31821964ba] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Haque A, Raisanen JM, Barnett SL, Samson DS. Infected giant ophthalmic artery aneurysm remnant following craniotomy for surgical clip ligation. Case report. J Neurosurg 2010; 113:786-9. [PMID: 20345224 DOI: 10.3171/2010.3.jns091892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Postoperative intracranial infections, although found in only a minority of surgical cases, remain a recognized potential complication following elective craniotomy. In the treatment of intracranial aneurysms, specifically, reports of significant postoperative infections are rare. Significant postoperative infections are usually observed in association with foreign bodies, such as aneurysm clips, endovascular coils, or materials used for aneurysm wrapping. The authors present a case in which a patient underwent craniotomy for surgical clip ligation of a giant ophthalmic artery aneurysm without resection of the aneurysm mass; the patient then presented again approximately 4 months later with a first-time seizure. Following a second craniotomy for resection of the aneurysm mass, the aneurysm contents were noted on pathological examination to contain gram-positive rods, and the aneurysm wall was noted to contain inflammatory cells. Although cultures were not obtained, Propionibacterium acnes was detected using polymerase chain reaction. To the best of the authors' knowledge, this case represents the second reported case of an intraaneurysmal abscess and the first reported instance of a presumed secondary infection of a giant intracranial aneurysm remnant following surgical clip ligation.
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Affiliation(s)
- Atif Haque
- Department of Neurological Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas 75390-8855, USA
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15
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Propionibacterium skull osteomyelitis treated with daptomycin. Clin Neurol Neurosurg 2009; 111:610-2. [PMID: 19450922 DOI: 10.1016/j.clineuro.2009.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 04/15/2009] [Accepted: 04/21/2009] [Indexed: 11/23/2022]
Abstract
Propionibacterium acnes (P. acnes) is emerging as a pathogen in postneurosurgical infections. A case of cranial bone flap infection due to P. acnes successfully treated with daptomycin is presented. This case demonstrates the potential of daptomycin as an option in the treatment of P. acnes.
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17
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Abstract
STUDY DESIGN A retrospective study about Propionibacterium acnes infections after Cotrel-Dubousset (CD) instrumentation. OBJECTIVES To analyze the significance of P. acnes-positive deep samples after CD. SUMMARY OF BACKGROUND DATA The diagnosis of spinal infections to P. acnes after CD is difficult. METHODS Patients with revision surgery and at least 1 P. acnes-positive deep sample, between 2000 and 2006 were included. Group A had 1 revision surgery and group B had 2 successive revision surgeries, with P. acnes-positive deep samples. Group A was divided into 2 subgroups according to the peroperative macroscopic aspect, subgroup A1 with septic tissues, subgroup A2 without septic tissues. The biologic characteristics of the patients and the surgical and medical treatments were assessed. RESULTS Sixty-eight patients were included, 60 in group A (A1 = 33, A2 = 27) and 8 in group B. Group A: 26 patients had 1 or 2 P. acnes-positive samples and 34 had at least 3 P. acnes-positive samples. Histology showed chronic inflammatory changes. C-reactive protein value median rate was 42 (A1) and 5 mg/L (A2). Twenty-two patients had a complete implant removal (14 with antibiotics, A1 = 12, A2 = 2). Nine patients had a total implant replacement (7 with antibiotics). Twenty-two patients had a partial implant removal (17 with antibiotics, A1 = 5, A2 = 12). Seven A1 patients had an irrigation and debridement (6 with antibiotics). The evolution was favorable for 28 patients. Seven patients had a documented sepsis. Group B: during the first revision, 8 patients had a partial implant removal (2 with antibiotics); during the second revision, all patients received antibiotics 4 of whom had a total implant removal. The long-term evolution was favorable for 6 patients. CONCLUSION P. acnes infection of spinal instrumentation is difficult to diagnose. Results of at least 4 deep sample cultures, histology, and C-reactive protein values must be compared to the peroperative macroscopic aspect.
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Re: Propionibacterium Acnes Infections after Cranial Neurosurgery. Can J Neurol Sci. 2006;33:292-5. Can J Neurol Sci 2006. [DOI: 10.1017/s0317167100119948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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