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Otto-Lambertz C, Yagdiran A, Boschert AL, Eysel P, Walker SV. Detection of Cutibacterium (Propionibacterium) acnes in orthopaedic surgery: serious problem or contamination? INTERNATIONAL ORTHOPAEDICS 2024; 48:337-344. [PMID: 37730929 PMCID: PMC10799792 DOI: 10.1007/s00264-023-05981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Bone and joint infections are an important and increasing problem. Whether intraoperatively detected bacteria should be considered relevant or not is often difficult to assess. This retrospective cohort study analyzes the relevance of C. acnes cultured from deep intraoperative specimens. METHODS All deep tissue samples collected intraoperatively between 2015 and 2020 from a quartiary care provider were evaluated for detection of C. acnes and its therapeutical consequences. Infection rates were determined according to a standardized definition and protocol and analyzed in dependence of patient's demographic data (age and gender), operative parameters (type of surgery, body region/location of surgery, and impression of the surgeon), and initiated therapy. RESULTS In 270 cases of more than 8500 samples, C. acnes was detected. In 30%, the detection was considered an infection. The number of samples taken and tested positive for C. acnes correlated significantly with its classification as a cause of infection. If more than one sample of the patient was positive, the detection was significantly more likely to be treated as infection (p < 0.001). In 76% of cases, a consultation to the infectious diseases (ID) department took place regarding the classification of the pathogen detection and the therapy to be carried out. Almost all of the tested isolates demonstrated the wild-type susceptibility for penicillin and clindamycin. CONCLUSION Intraoperative detection of skin-colonizing bacteria such as C. acnes is not always synonymous with infection. In particular, if other examination results contradict an infection (pathological sample without evidence of an infectious event, detection of malignant cells, etc.), the situation must be considered in a very differentiated manner. Interdisciplinary boards, for example, are suitable for this purpose. Care should be taken to obtain a sufficiently large number of tissue samples for microbiological examination to be able to better classify the result.
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Affiliation(s)
- Christina Otto-Lambertz
- Department of Orthopaedic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Ayla Yagdiran
- Department of Orthopaedic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alessa Lalinka Boschert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany
| | - Peer Eysel
- Department of Orthopaedic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Sarah Victoria Walker
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany
- German Centre for Infection Research (DZIF), Hannover, Germany
- Institute for Clinical Microbiology and Hospital Hygiene, Hospital Ludwigsburg, Ludwigsburg, Germany
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2
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Kurihara MNL, Santos INM, Eisen AKA, Caleiro GS, de Araújo J, de Sales RO, Pignatari AC, Salles MJ. Phenotypic and Genotypic Characterization of Cutibacterium acnes Isolated from Shoulder Surgery Reveals Insights into Genetic Diversity. Microorganisms 2023; 11:2594. [PMID: 37894252 PMCID: PMC10609031 DOI: 10.3390/microorganisms11102594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Specific virulence factors that likely influence C. acnes invasion into deep tissues remain to be elucidated. Herein, we describe the frequency of C. acnes identification in deep tissue specimens of patients undergoing clean shoulder surgery and assess its phenotypic and genetic traits associated with virulence and antibiotic resistance patterns, compared with isolates from the skin of healthy volunteers. Multiple deep tissue specimens from the bone fragments, tendons, and bursa of 84 otherwise healthy patients undergoing primary clean-open and arthroscopic shoulder surgeries were aseptically collected. The overall yield of tissue sample cultures was 21.5% (55/255), with 11.8% (30/255) identified as C. acnes in 27.3% (23/84) of patients. Antibiotic resistance rates were low, with most strains expressing susceptibility to first-line antibiotics, while a few were resistant to penicillin and rifampicin. Phylotypes IB (73.3%) and II (23.3%) were predominant in deep tissue samples. Genomic analysis demonstrated differences in the pangenome of the isolates from the same clade. Even though strains displayed a range of pathogenic markers, such as biofilm formation, patients did not evolve to infection during the 1-year follow-up. This suggests that the presence of polyclonal C. acnes in multiple deep tissue samples does not necessarily indicate infection.
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Affiliation(s)
- Mariana Neri Lucas Kurihara
- Laboratório Especial de Microbiologia Clínica (LEMC), Departamento de Medicina, Escola Paulista de Medicina (EPM), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo 04025-010, Brazil; (M.N.L.K.); (I.N.M.S.); (A.C.P.)
| | - Ingrid Nayara Marcelino Santos
- Laboratório Especial de Microbiologia Clínica (LEMC), Departamento de Medicina, Escola Paulista de Medicina (EPM), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo 04025-010, Brazil; (M.N.L.K.); (I.N.M.S.); (A.C.P.)
| | - Ana Karolina Antunes Eisen
- Emerging Viruses Research Laboratory, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil; (A.K.A.E.); (G.S.C.); (J.d.A.)
| | - Giovana Santos Caleiro
- Emerging Viruses Research Laboratory, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil; (A.K.A.E.); (G.S.C.); (J.d.A.)
| | - Jansen de Araújo
- Emerging Viruses Research Laboratory, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil; (A.K.A.E.); (G.S.C.); (J.d.A.)
| | - Romário Oliveira de Sales
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil;
| | - Antônio Carlos Pignatari
- Laboratório Especial de Microbiologia Clínica (LEMC), Departamento de Medicina, Escola Paulista de Medicina (EPM), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo 04025-010, Brazil; (M.N.L.K.); (I.N.M.S.); (A.C.P.)
| | - Mauro José Salles
- Laboratório Especial de Microbiologia Clínica (LEMC), Departamento de Medicina, Escola Paulista de Medicina (EPM), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo 04025-010, Brazil; (M.N.L.K.); (I.N.M.S.); (A.C.P.)
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3
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Kohm K, Seneca K, Smith K, Heinemann D, Nahass RG. Successful Treatment of Cutibacterium acnes Prosthetic Joint Infection With Single-Stage Exchange and Oral Antibiotics. Open Forum Infect Dis 2023; 10:ofad370. [PMID: 37539065 PMCID: PMC10394724 DOI: 10.1093/ofid/ofad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
Interest has grown in less invasive surgical treatment and early use of oral antibiotics in the treatment of Cutibacterium acnes prosthetic joint infection. We report a series of patients who were successfully treated with single-stage exchange and an all-oral course of rifampin and linezolid.
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Affiliation(s)
- Kevin Kohm
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | | | | | - Ronald G Nahass
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- ID Care, Hillsborough New Jersey, USA
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4
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Wouthuyzen-Bakker M, Scheper H. Rifampicin in periprosthetic joint infections: where do we stand and where are we headed? Expert Rev Anti Infect Ther 2023:1-7. [PMID: 37141111 DOI: 10.1080/14787210.2023.2211263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION A periprosthetic joint infection (PJI) is a major complication of arthroplasty. Treatment of PJI consists of surgical debridement with or without the exchange of the implant and long-term antimicrobial treatment. Rifampicin is regarded as one of the cornerstones of antimicrobial treatment for staphylococcal PJI, but the exact role of rifampicin for PJI in different clinical scenarios remains to be elucidated. AREAS COVERED In this perspective article, an overview is provided of in vitro, in vivo and clinical studies that were the basis of the current guidelines and recommendations for rifampicin use in daily practice for PJI. Controversial issues on indication, dosing, timing, duration and antibiotic drug interactions will be addressed. Finally, the most urgent clinical questions on rifampicin use that need answering in the nearby future will be formulated. EXPERT OPINION Many inquiries remain concerning the exact indications and clinical use of rifampicin in PJI. Randomized controlled trials are needed to answer these questions.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of medical microbiology and infection prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Scheper
- Department of infectious diseases, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
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5
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Lacasse M, Derolez S, Bonnet E, Amelot A, Bouyer B, Carlier R, Coiffier G, Cottier JP, Dinh A, Maldonado I, Paycha F, Ziza JM, Bemer P, Bernard L. 2022 SPILF - Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults. Infect Dis Now 2023; 53:104647. [PMID: 36690329 DOI: 10.1016/j.idnow.2023.01.007] [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: 12/08/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
These guidelines are an update of those made in 2007 at the request of the French Society of Infectious Diseases (SPILF, Société de Pathologie Infectieuse de Langue Française). They are intended for use by all healthcare professionals caring for patients with disco-vertebral infection (DVI) on spine, whether native or instrumented. They include evidence and opinion-based recommendations for the diagnosis and management of patients with DVI. ESR, PCT and scintigraphy, antibiotic therapy without microorganism identification (except for emergency situations), therapy longer than 6 weeks if the DVI is not complicated, contraindication for spinal osteosynthesis in a septic context, and prolonged dorsal decubitus are no longer to be done in DVI management. MRI study must include exploration of the entire spine with at least 2 orthogonal planes for the affected level(s). Several disco-vertebral samples must be performed if blood cultures are negative. Short, adapted treatment and directly oral antibiotherapy or early switch from intravenous to oral antibiotherapy are recommended. Consultation of a spine specialist should be requested to evaluate spinal stability. Early lifting of patients is recommended.
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Affiliation(s)
- M Lacasse
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - S Derolez
- Rhumatologie, 125 rue de Stalingrad, CHU Avicenne, 93000 Bobigny, France
| | - E Bonnet
- Maladies Infectieuses, Pl. Dr Baylac, CHU Purpan, 31000 Toulouse, France.
| | - A Amelot
- Neurochirurgie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - B Bouyer
- Chirurgie orthopédique et traumatologique, CHU de Bordeaux, Place Amélie Raba-léon, 33076 Bordeaux, France
| | - R Carlier
- Imagerie, Hôpital Raymond Poincaré, 104 Bd R Poincaré, 92380 Garches, France
| | - G Coiffier
- Rhumatologie, GH Rance-Emeraude, Hôpital de Dinan, 22100 Dinan, France
| | - J P Cottier
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - A Dinh
- Maladies Infecteiuses, CHU Raymond Poicaré, 92380 Garches, France
| | - I Maldonado
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - F Paycha
- Médecine Nucléaire, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France
| | - J M Ziza
- Rhumatologie et Médecine Interne. GH Diaconesses Croix Saint Simon, 75020 Paris, France
| | - P Bemer
- Microbiologie, CHU de Nantes, 1 Place A. Ricordeau, Nantes 44000 Cedex 1, France
| | - L Bernard
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
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Renz N, Madjarevic T, Ferrari M, Becker R, Ravn C, Vogely C, Pérez-Prieto D. Recommendations on diagnosis and antimicrobial treatment of infections after anterior cruciate ligament reconstruction (ACL-R) endorsed by ESSKA and EBJIS. J Infect 2023; 86:543-551. [PMID: 37019288 DOI: 10.1016/j.jinf.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Infection after anterior-cruciate ligament reconstruction (ACL-R) is a rare but devastating complication affecting predominantly young and sportive individuals. A timely and correct diagnosis as well as an optimized management are paramount to circumvent serious sequelae and compromise in life quality. These recommendations are primarily intended for use by infectious disease specialists and microbiologists, but also orthopedic surgeons and other healthcare professionals who care for patients with infections after ACL-R. They are based on evidence mainly originating from observational studies and opinions of experts in the field and cover the management of infections after ACL-R with a special focus on etiology, diagnosis, antimicrobial treatment and prevention. Comprehensive recommendations on prevention, surgical treatment and rehabilitation are presented separately in a document primarily addressing orthopedics professionals.
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Affiliation(s)
- Nora Renz
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany.
| | - Tomislav Madjarevic
- University Hospital for Orthopaedic Surgery Lovran, Faculty of Medicine of the University of Rijeka, Rijeka, Croatia
| | - Matteo Ferrari
- Department of Internal Medicine, IRCCS Ospedale Galeazzi, Sant' Ambrogio, MIlan, Italy
| | - Roland Becker
- Centre for Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Christen Ravn
- Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel Pérez-Prieto
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar, Barcelona, Spain; IcatKNEE, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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7
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Núñez-Pereira S, Benavent E, Ulldemolins M, Sobrino-Díaz B, Iribarren JA, Escudero-Sánchez R, Del Toro MD, Nodar A, Sorli L, Bahamonde A, Vilchez HH, Gasch O, Muñez E, Rodríguez-Montserrat D, García-País MJ, Haddad S, Sellarès-Nadal J, Murillo O, Rodríguez-Pardo D. Cutibacterium spp. Infections after Instrumented Spine Surgery Have a Good Prognosis Regardless of Rifampin Use: A Cross-Sectional Study. Antibiotics (Basel) 2023; 12:antibiotics12030518. [PMID: 36978385 PMCID: PMC10044575 DOI: 10.3390/antibiotics12030518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Infection after spinal instrumentation (IASI) by Cutibacterium spp. is being more frequently reported. The aim of this study was to analyse the incidence, risk factors, clinical characteristics, and outcome of a Cutibacterium spp. IASI (CG) compared with non-Cutibacterium IASI (NCG) infections, with an additional focus on the role of rifampin in the treatment. All patients from a multicentre, retrospective, observational study with a confirmed IASI between January 2010 and December 2016 were divided into two groups: (CG and NCG) IASI. Baseline, medical, surgical, infection treatment, and follow-up data were compared for both groups. In total, 411 patients were included: 27 CG and 384 NCG. The CG patients were significantly younger. They had a longer median time to diagnosis (23 vs. 13 days) (p = 0.025), although 55.6% debuted within the first month after surgery. Cutibacterium patients were more likely to have the implant removed (29.6% vs. 12.8%; p = 0.014) and received shorter antibiotic regimens (p = 0.014). In 33% of Cutibacterium cases, rifampin was added to the baseline therapy. None of the 27 infections resulted in treatment failure during follow-up regardless of rifampin use. Cutibacterium spp. is associated with a younger age and may cause both early and late IASIs. In our experience, the use of rifampin to improve the outcome in the treatment of a Cutibacterium spp. IASI is not relevant since, in our series, none of the cases had therapeutic failure regardless of the use of rifampin.
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Affiliation(s)
- Susana Núñez-Pereira
- Spine Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
- Correspondence: (S.N.-P.); (D.R.-P.); Tel.: +34-934893480 (S.N.-P)
| | - Eva Benavent
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta Ulldemolins
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Beatriz Sobrino-Díaz
- Department of Infectious Diseases, Hospital Regional Universitario Málaga, 29011 Málaga, Spain
| | - José A. Iribarren
- Infectious Diseases Department, Hospital Universitario Donostia, 20014 Gipuzkoa, Spain
| | - Rosa Escudero-Sánchez
- Infectious Disease Department, University Hospital Ramón y Cajal, 28034 Madrid, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - María Dolores Del Toro
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
- Infectious Diseases Unit, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
- Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, 41009 Seville, Spain
| | - Andrés Nodar
- Infectious Diseases Unit, Internal Medicine Department, 36312 Vigo, Spain
- Instituto de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
| | - Luisa Sorli
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
- Infectious Diseases Department, Hospital del Mar, 08003 Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Alberto Bahamonde
- Department of Internal Medicine-Infectious Diseases, Hospital Universitario del Bierzo, 24411 Ponferrada, Spain
| | - Helem H. Vilchez
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Oriol Gasch
- Infectious Diseases Department, Hospital Parc Tauli de Sabadell, University Autonoma of Barcelona, 08208 Barcelona, Spain
| | - Elena Muñez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro-Majadahonda, 28222 Madrid, Spain
| | | | - María José García-País
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain
| | - Sleiman Haddad
- Spine Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Julia Sellarès-Nadal
- Infectious Diseases Department, Vall d’Hebron, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - Dolors Rodríguez-Pardo
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
- Infectious Diseases Department, Vall d’Hebron, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Correspondence: (S.N.-P.); (D.R.-P.); Tel.: +34-934893480 (S.N.-P)
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Rottier W, Seidelman J, Wouthuyzen-Bakker M. Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles. ARTHROPLASTY 2023; 5:10. [PMID: 36864531 PMCID: PMC9979546 DOI: 10.1186/s42836-023-00169-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/16/2023] [Indexed: 03/04/2023] Open
Abstract
The antibiotic treatment of periprosthetic joint infections (PJI) is complicated by the presence of biofilm produced by bacteria on the abiotic surface of the implant. Bacteria within the deeper layers of the biofilm become metabolically less active, resulting in antibiotic tolerance due to several mechanisms. This review describes the basic principles of antibiotic treatment in PJI in relation to the behavior of bacteria within the biofilm. The concept of biofilm-active antibiotics will be explained from an in vitro as well as in vivo perspective. Evidence from clinical studies on biofilm-active antibiotics in PJI will be highlighted, mainly focusing on the role of rifampicin for Gram-positive microorganisms and fluoroquinolones for Gram-negative microorganisms. The optimal treatment duration will be discussed as the timing of switching to oral antibiotic therapy.
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Affiliation(s)
- Wouter Rottier
- grid.4830.f0000 0004 0407 1981Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ the Netherlands
| | - Jessica Seidelman
- grid.26009.3d0000 0004 1936 7961Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27708 USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, the Netherlands.
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9
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Skedros JG, Finlinson ED, Luczak MG, Cronin JT. Septic Olecranon Bursitis With Osteomyelitis Attributed to Cutibacterium acnes: Case Report and Literature Overview of the Dilemma of Potential Contaminants and False-Positives. Cureus 2023; 15:e34563. [PMID: 36879721 PMCID: PMC9985484 DOI: 10.7759/cureus.34563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
We report an unusual case of acute septic olecranon bursitis, with probable olecranon osteomyelitis, where the only organism isolated in culture was initially considered a contaminant, Cutibacterium acnes. However, we ultimately considered it the likely causal organism when treatment for most of the other more likely organisms failed. This typically indolent organism is prevalent in pilosebaceous glands, which are scarce in the posterior elbow region. This case illustrates the often challenging empirical management of a musculoskeletal infection when the only organism isolated might be a contaminant, but successful eradication requires continued treatment as if it is the causal organism. The patient is a Caucasian 53-year-old male who presented to our clinic with a second episode of septic bursitis at the same location. Four years prior, he had septic olecranon bursitis from methicillin-sensitive Staphylococcus aureus that was treated uneventfully with one surgical debridement and a one-week course of antibiotics. In the current episode reported here, he sustained a minor abrasion. Cultures were obtained five separate times because of no growth and difficulty eradicating the infection. One culture grew C. acnes on day 21 of incubation; this long duration has been reported. The first several weeks of antibiotic treatment failed to eradicate the infection, which we ultimately attributed to inadequate treatment of C. acnes osteomyelitis. Although C. acnes has a well-known propensity for false-positive cultures as typically reported in post-operative shoulder infections, treatment for our patient's olecranon bursitis/osteomyelitis was successful only after several surgical debridements and a prolonged course of intravenous and oral antibiotics that targeted it as the presumptive causal organism. However, it was possible that C. acnes was a contaminant/superinfection, and another organism was the culprit, such as a Streptococcus or Mycobacterium species that was eradicated by the treatment regime targeted for C. acnes.
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Affiliation(s)
- John G Skedros
- Shoulder and Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA.,Department of Orthopaedics, University of Utah, Salt Lake City, USA
| | - Ethan D Finlinson
- Shoulder and Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
| | - Meredith G Luczak
- Shoulder and Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
| | - John T Cronin
- Shoulder and Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
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10
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Saltiel G, Meyssonnier V, Kerroumi Y, Heym B, Lidove O, Marmor S, Zeller V. Cutibacterium acnes Prosthetic Joint Infections: Is Rifampicin-Combination Therapy Beneficial? Antibiotics (Basel) 2022; 11:antibiotics11121801. [PMID: 36551458 PMCID: PMC9774273 DOI: 10.3390/antibiotics11121801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/26/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
No consensus has been reached on the optimal antibiotic regimen to treat Cutibacterium acnes PJIs (Ca-PJIs). In vitro studies showed excellent rifampicin efficacy against biofilm-associated C. acnes infections, but clinical studies did not confirm the superiority of rifampicin-combined therapy over monotherapy. This prospective cohort study was undertaken to analyze the outcomes of 70 patients who underwent exchange arthroplasty for chronic monomicrobial Ca-PJI and were treated with rifampicin or without between 2004 and 2019. The 37 patients treated from January 2004 to August 2014 were prescribed rifampicin-combination therapy and the 33 treated from September 2014 to December 2019 received monotherapy without rifampicin. The primary endpoint was the 2-year Kaplan-Meier-estimated reinfection-free probability, including relapses and new-pathogen PJIs. The 2-year reinfection-free rate was high and not different for patients who had received rifampicin or not (89.2% vs. 93.8%, respectively; p = 0.524). None of the patients relapsed and six developed new-pathogen PJIs. Our results do not support a benefit of rifampicin-combination therapy for patients who underwent exchange arthroplasty for chronic Ca-PJIs.
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Affiliation(s)
- Grégoire Saltiel
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Vanina Meyssonnier
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Beate Heym
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Laboratoire des Centres de Santé et Hôpitaux d’Île-de-France, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Olivier Lidove
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Correspondence: ; Tel.: +33-1-44-64-17-80
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11
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Salar-Vidal L, Aguilera-Correa JJ, Brüggemann H, Achermann Y, Esteban J. Microbiological Characterization of Cutibacterium acnes Strains Isolated from Prosthetic Joint Infections. Antibiotics (Basel) 2022; 11:antibiotics11091260. [PMID: 36140039 PMCID: PMC9495218 DOI: 10.3390/antibiotics11091260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Aims: This study aimed to characterize 79 Cutibacterium acnes strains isolated from prosthetic joint infections (PJIs) originated from eight European hospitals. Methods: Isolates were phylotyped according to the single-locus sequence typing (SLST) scheme. We evaluated the ability of the biofilm formation of C. acnes strains isolated from PJIs and 84 isolates recovered from healthy skin. Antibiotic susceptibility testing of planktonic and biofilm cells of PJI isolates and skin isolates was performed. Results: Most of the isolates from PJIs belonged to the SLST class H/phylotype IB (34.2%), followed by class D/phylotype IA1 (21.5%), class A/phylotype IA1 (18.9%), and class K/phylotype II (13.9%). All tested isolates were biofilm producers; no difference in biofilm formation was observed between the healthy skin group and the PJI group of strains. Planktonic and sessile cells of C. acnes remained highly susceptible to a broad spectrum of antibiotics, including beta-lactams, clindamycin, fluoroquinolones, linezolid, rifampin, and vancomycin. The minimal inhibitory concentrations (MICs) for planktonic and biofilm states coincided in most cases. However, the minimal biofilm eradication concentration (MBEC) was high for all antimicrobial drugs tested (>32 mg/L), except for rifampin (2 mg/L). Conclusions: C. acnes strains isolated from healthy skin were able to produce biofilm to the same extent as isolates recovered from PJIs. All C. acnes strains in planktonic and sessile states were susceptible to most antibiotics commonly used for PJI treatment, although rifampin was the only antimicrobial agent able to eradicate C. acnes embedded in biofilm.
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Affiliation(s)
- Llanos Salar-Vidal
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, 28020 Madrid, Spain
- CIBER de EnfermedadesInfecciosas (CIBERINFEC), 28020 Madrid, Spain
- Correspondence: ; Tel.: +34-915504900
| | - John Jairo Aguilera-Correa
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, 28020 Madrid, Spain
- CIBER de EnfermedadesInfecciosas (CIBERINFEC), 28020 Madrid, Spain
| | | | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich (USZ), 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich (UZH), 8091 Zurich, Switzerland
- Internal Medicine, Hospital Zollikerberg, 8091 Zurich, Switzerland
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, 28020 Madrid, Spain
- CIBER de EnfermedadesInfecciosas (CIBERINFEC), 28020 Madrid, Spain
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12
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Higashihira S, Simpson SJ, Collier CD, Natoli RM, Kittaka M, Greenfield EM. Halicin Is Effective Against Staphylococcus aureus Biofilms In Vitro. Clin Orthop Relat Res 2022; 480:1476-1487. [PMID: 35583504 PMCID: PMC9278916 DOI: 10.1097/corr.0000000000002251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biofilms protect bacteria from the host immune system and many antibiotics, making the treatment of orthopaedic infections difficult. Halicin, a recently discovered antibiotic, has potent activity against nonorthopaedic infections in mice and the planktonic, free-living forms of many bacterial species, including Staphylococcus aureus , a common cause of orthopaedic infections. Importantly, halicin did not induce resistance in vitro and was effective against drug-resistant bacteria and proliferating and quiescent bacteria. Quiescence is an important cause of antibiotic tolerance in biofilms. However, whether halicin acts on biofilms has not been tested. QUESTIONS/PURPOSES (1) Does halicin reduce the viability of S. aureus in less mature and more mature biofilms as it does in planktonic cultures? (2) How do the relative effects of halicin on S. aureus biofilms and planktonic cultures compare with those of conventional antibiotics (tobramycin, cefazolin, vancomycin, or rifampicin) that are commonly used in clinical orthopaedic infections? METHODS To measure minimal biofilm eradication concentrations (MBECs) with less mature 3-day and more mature 7-day biofilms, we used 96-well peg plates that provided high throughput and excellent reproducibility. After S. aureus -Xen36 biofilm formation, planktonic bacteria were removed from the cultures, and the biofilms were exposed to various concentrations of halicin, tobramycin, cefazolin, vancomycin, or rifampicin for 20 hours. Biofilm viability was determined by measuring resazurin reduction or by counting colony-forming units after sonication. To determine effects of halicin and the conventional antibiotics on biofilm viability, we defined MBEC 75 as the lowest concentration that decreased viability by 75% or more. To determine effects on bacterial viability in planktonic cultures, minimum inhibitory concentrations (MICs) were determined with the broth dilution method. Each result was measured in four to 10 independent experiments. RESULTS We found no differences between halicin's effectiveness against planktonic S. aureus and 3-day biofilms (MIC and MBEC 75 for 3-day biofilms was 25 μM [interquartile range 25 to 25 and 25 to 25, respectively]; p > 0.99). Halicin was eightfold less effective against more mature 7-day biofilms (MBEC 75 = 200 μM [100 to 200]; p < 0.001). Similarly, tobramycin was equally effective against planktonic culture and 3-day biofilms (MIC and MBEC 75 for 3-day biofilms was 20 μM [20 to 20 and 10 to 20, respectively]; p > 0.99). Tobramycin's MBEC 75 against more mature 7-day biofilms was 320 μM (320 to 480), which is 16-fold greater than its planktonic MIC (p = 0.03). In contrast, the MBEC 75 for cefazolin, vancomycin, and rifampicin against more mature 7-day biofilms were more than 1000-fold (> 1000; p < 0.001), 500-fold (500 to 875; p < 0.001), and 3125-fold (3125 to 5469; p = 0.004) greater than their planktonic MICs, respectively, consistent with those antibiotics' relative inactivity against biofilms. CONCLUSION Halicin was as effective against S. aureus in less mature 3-day biofilms as those in planktonic cultures, but eightfold higher concentrations were needed for more mature 7-day biofilms. Tobramycin, an antibiotic whose effectiveness depends on biofilm maturity, was also as effective against S. aureus in less mature 3-day biofilms as those in planktonic cultures, but 16-fold higher concentrations were needed for more mature 7-day biofilms. In contrast, cefazolin, vancomycin, and rifampicin were substantially less active against both less and more mature biofilms than against planktonic cultures. CLINICAL RELEVANCE Halicin is a promising antibiotic that may be effective against S. aureus osteomyelitis and infections on orthopaedic implants. Future studies should assess the translational value of halicin by testing its effects in animal models of orthopaedic infections; on the biofilms of other bacterial species, including multidrug-resistant bacteria; and in combination therapy with conventional antibiotics.
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Affiliation(s)
- Shota Higashihira
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Stefanie Jan Simpson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher David Collier
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Roman Michael Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mizuho Kittaka
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Edward Michael Greenfield
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
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Clindamycin Efficacy for Cutibacterium acnes Shoulder Device-Related Infections. Antibiotics (Basel) 2022; 11:antibiotics11050608. [PMID: 35625252 PMCID: PMC9137462 DOI: 10.3390/antibiotics11050608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
Clindamycin is an antibiotic with high bioavailability and appropriate bone diffusion, often proposed as an alternative in guidelines for C. acnes prosthetic joint infections. We aimed to evaluate the efficacy of clindamycin in the treatment of C. acnes shoulder implant joint infections (SIJI). Methods: A retrospective analysis was conducted at the University Hospital of Nice (France) between 2010 and 2019. We included patients with one shoulder implant surgical procedure and at least one C. acnes positive sample. We selected the C. acnes SIJI according to French and international recommendations. The primary endpoint was favorable outcome of C. acnes SIJI treatment after at least 1-year follow-up in the clindamycin group compared to another therapeutic group. Results: Forty-eight SIJI were identified and 33 were treated with clindamycin, among which 25 were treated with monotherapy. The median duration of clindamycin antibiotherapy was 6 weeks. The average follow-up was 45 months; one patient was lost to follow-up. Twenty-seven patients out of 33 (82%) were cured with clindamycin, compared to 9/12 (75%) with other antibiotics. The rate of favorable outcomes increased to 27/31 (87%) with clindamycin and to 9/10 (90%) for other antibiotics when no septic revision strategies were excluded (P = 1.00). Conclusions: The therapeutic strategy based on one- or two-stage revision associated with 6 weeks of clindamycin seems to be effective.
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14
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Antibiotic Therapy for Prosthetic Joint Infections: An Overview. Antibiotics (Basel) 2022; 11:antibiotics11040486. [PMID: 35453237 PMCID: PMC9025623 DOI: 10.3390/antibiotics11040486] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 02/04/2023] Open
Abstract
Prosthetic joint infection (PJI) is a severe complication after arthroplasty. Its management combines surgical intervention, whose type depends on the clinical situation, and prolonged high-dose antibiotics adapted to the responsible microorganism(s) and the patient. Antibiotics are only one part of the therapeutic regimen and are closely related to the surgical strategy. Their efficacy depends to a large extent on the choice and quality of the surgical procedure, and the quality of the microbiological diagnosis. Although guidelines have been published, many aspects of antibiotic therapy remain poorly established. Choosing the optimal agent(s) is one aspect, with others being optimization of drugs’ pharmacokinetic/pharmacodynamic parameters, the choice of administration route, use of monotherapy or combination regimens, therapeutic drug-monitoring and patient education to improve compliance and tolerance. Herein, we address PJI management based on recent literature data, guidelines and the experience of our referral center for complex bone-and-joint infections.
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15
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ElAttar Y, Mourad B, Alngomy HA, Deen ASE, Ismail M. Study of Interleukin-1Beta Expression in Acne Vulgaris and Acne Scars. J Cosmet Dermatol 2022; 21:4864-4870. [PMID: 35174608 DOI: 10.1111/jocd.14852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/16/2022] [Accepted: 02/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acne vulgaris is a multifactorial disease that mostly heals by scarring. Interleukin-1 beta (IL-1β) is a proinflammatory cytokine, suggested to play a key role in acne pathogenesis. OBJECTIVE To study the immunohistochemical (IHC) expression of IL1β in acne vulgaris and acne scars to evaluate its possible role in their pathogenesis and to study the relation between expression of IL1β and the clinicopathological parameters. PATIENTS AND METHODS This study was conducted on sixty subjects (twenty patients with acne vulgaris and twenty patients with acne scars), and twenty healthy volunteers as controls. Skin biopsies were taken from patients and controls for routine histopathological examination with Hematoxylin and Eosin (H&E) stain and IHC staining of IL-1β. RESULTS There was a statistically significant increase in expression of IL-1β in acne vulgaris compared to post-acne scars and controls, (p<0.001) for both. IL-1β expression was significantly positively correlated with both clinical severity of acne vulgaris (p=0.022) and severity of histopathological inflammation (p=0.011). CONCLUSION IL-1β expression was associated with acne vulgaris and post acne scars with significant positive correlation to clinical and histopathological severity of acne vulgaris. Thus IL-1β could be a key player cytokine in acne pathogenesis, its severity and development of post acne scars.
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Affiliation(s)
- Yasmina ElAttar
- Department of Dermatology and Venereology, Faculty of medicine, Tanta University, Tanta, Egypt
| | - Basma Mourad
- Department of Dermatology and Venereology, Faculty of medicine, Tanta University, Tanta, Egypt
| | | | - Aliaa Shams El Deen
- Department of Pathology, Faculty of medicine, Tanta University, Tanta, Egypt
| | - Mayada Ismail
- Department of Dermatology and Venereology, Faculty of medicine, Tanta University, Tanta, Egypt
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The Anticancer Agent 3,3'-Diindolylmethane Inhibits Multispecies Biofilm Formation by Acne-Causing Bacteria and Candida albicans. Microbiol Spectr 2022; 10:e0205621. [PMID: 35107361 PMCID: PMC8809333 DOI: 10.1128/spectrum.02056-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Gram-positive anaerobic bacterium Cutibacterium acnes is a major inhabitant of human skin and has been implicated in acne vulgaris formation and in the formation of multispecies biofilms with other skin-inhabiting organisms like Staphylococcus aureus and Candida albicans. Indoles are widespread in nature (even in human skin) and function as important signaling molecules in diverse prokaryotes and eukaryotes. In the present study, we investigated the antibacterial and antibiofilm activities of 20 indoles against C. acnes. Of the indoles tested, indole-3-carbinol at 0.1 mM significantly inhibited biofilm formation by C. acnes without affecting planktonic cell growth, and the anticancer drug 3,3'-diindolylmethane (DIM) at 0.1 mM (32 μg/mL) also significantly inhibited planktonic cell growth and biofilm formation by C. acnes, whereas the other indoles and indole itself were less effective. Also, DIM at 0.1 mM successfully inhibited multispecies biofilm formation by C. acnes, S. aureus, and C. albicans. Transcriptional analyses showed that DIM inhibited the expressions of several biofilm-related genes in C. acnes, and at 0.05 mM, DIM inhibited hyphal formation and cell aggregation by C. albicans. These results suggest that DIM and other indoles inhibit biofilm formation by C. acnes and have potential use for treating C. acnes associated diseases. IMPORTANCE Since indoles are widespread in nature (even in human skin), we hypothesized that indole and its derivatives might control biofilm formation of acne-causing bacteria (Cutibacterium acnes and Staphylococcus aureus) and fungal Candida albicans. The present study reports for the first time the antibiofilm and antimicrobial activities of several indoles on C. acnes. Of the indoles tested, two anticancer agents, indole-3-carbinol and 3,3'-diindolylmethane found in cruciferous vegetables, significantly inhibited biofilm formation by C. acnes. Furthermore, the most active 3,3'-diindolylmethane successfully inhibited multispecies biofilm formation by C. acnes, S. aureus, and C. albicans. Transcriptional analyses showed that 3,3'-diindolylmethane inhibited the expressions of several biofilm-related genes including lipase, hyaluronate lyase, and virulence-related genes in C. acnes, and 3,3'-diindolylmethane inhibited hyphal formation and cell aggregation by C. albicans. Our findings show that 3,3'-diindolylmethane offers a potential means of controlling acne vulgaris and multispecies biofilm-associated infections due to its antibiofilm and antibiotic properties.
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Coenye T, Spittaels KJ, Achermann Y. The role of biofilm formation in the pathogenesis and antimicrobial susceptibility of Cutibacterium acnes. Biofilm 2021; 4:100063. [PMID: 34950868 PMCID: PMC8671523 DOI: 10.1016/j.bioflm.2021.100063] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/20/2022] Open
Abstract
Cutibacterium acnes (previously known as Propionibacterium acnes) is frequently found on lipid-rich parts of the human skin. While C. acnes is most known for its role in the development and progression of the skin disease acne, it is also involved in many other types of infections, often involving implanted medical devices. C. acnes readily forms biofilms in vitro and there is growing evidence that biofilm formation by this Gram-positive, facultative anaerobic micro-organism plays an important role in vivo and is also involved in treatment failure. In this brief review we present an overview on what is known about C. acnes biofilms (including their role in pathogenesis and reduced susceptibility to antibiotics), discuss model systems that can be used to study these biofilms in vitro and in vivo and give an overview of interspecies interactions occurring in polymicrobial communities containing C. acnes.
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Affiliation(s)
- Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
| | - Karl-Jan Spittaels
- Laboratory of Pharmaceutical Microbiology, Ghent University, Gent, Belgium
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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18
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Götte L, Rübberdt A. [Salvage procedure for chronic periprosthetic infection : Use of a rifampicin-loaded polymethyl methacrylate spacer]. Unfallchirurg 2021; 125:497-500. [PMID: 34878580 DOI: 10.1007/s00113-021-01048-w] [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] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
Periprosthetic infections with problematic and multiresistant pathogens represent a great challenge for trauma surgeons, especially when repetitive surgical débridement combined with calculated i.v. antibiotic treatment does not lead to resolution of the infection. This can necessitate a deviation from state of the art treatment concepts, such as the additive implementation of a rifampicin-loaded polymethyl methacrylate (PMMA) spacers.
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Affiliation(s)
- Lea Götte
- Zentrum für Orthopädie und Unfallchirurgie, Unfallchirurgische Klinik, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Teutoburger Straße 50, 33604, Bielefeld, Deutschland.
| | - Alexander Rübberdt
- Zentrum für Orthopädie und Unfallchirurgie, Unfallchirurgische Klinik, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Teutoburger Straße 50, 33604, Bielefeld, Deutschland
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19
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Oliva A, Stefani S, Venditti M, Di Domenico EG. Biofilm-Related Infections in Gram-Positive Bacteria and the Potential Role of the Long-Acting Agent Dalbavancin. Front Microbiol 2021; 12:749685. [PMID: 34745053 PMCID: PMC8569946 DOI: 10.3389/fmicb.2021.749685] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Infections caused by Gram-positive bacteria are a major public health problem due to their increasing resistance to antibiotics. Staphylococcus and Enterococcus species' resistance and pathogenicity are enhanced by their ability to form biofilm. The biofilm lifestyle represents a significant obstacle to treatment because bacterial cells become highly tolerant to a wide range of antimicrobial compounds normally effective against their planktonic forms. Thus, novel therapeutic strategies targeting biofilms are urgently needed. The lipoglycopeptide dalbavancin is a long-acting agent for treating acute bacterial skin and skin structure infections caused by a broad range of Gram-positive pathogens. Recent studies have shown promising activity of dalbavancin against Gram-positive biofilms, including methicillin-resistant S. aureus (MRSA), methicillin-resistant S. epidermidis (MRSE), and vancomycin-susceptible enterococci. This review outlines the mechanisms regulating biofilm development in Staphylococcus and Enterococcus species and the clinical impact of biofilm-related infections. In addition, it discusses the clinical implications and potential therapeutic perspectives of the long-acting drug dalbavancin against biofilm-forming Gram-positive pathogens.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, "La Sapienza" University of Rome, Rome, Italy
| | - Stefania Stefani
- Laboratory of Molecular Medical Microbiology and Antimicrobial Resistance Research (Mmarl), Department of Biomedical and Biotechnological Sciences (Biometec), University of Catania, Catania, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, "La Sapienza" University of Rome, Rome, Italy
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Torrens C, Bellosillo B, Gibert J, Alier A, Santana F, Prim N, Corvec S. Are Cutibacterium acnes present at the end of primary shoulder prosthetic surgeries responsible for infection? Prospective study. Eur J Clin Microbiol Infect Dis 2021; 41:169-173. [PMID: 34535842 DOI: 10.1007/s10096-021-04348-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate if the C. acnes present at the end of a primary shoulder arthroplasty could be responsible for shoulder arthroplasty infection. Prospective study includes patients undergoing primary shoulder arthroplasty from January 2015 until December 2018. From all the patients included, 5 to 12 tissue samples were obtained and were specifically cultured to detect the presence of C. acnes. DNA was extracted from the C acnes isolated colonies and Whole Genome Sequencing (WGS) analysis was done. A cohort of 156 patients was finally included. In twenty-seven patients, the C. acnes was present at the end of the primary surgery. Two of these patients developed a C. acnes periprosthetic shoulder infection at 6 and 4 months after the primary surgery. WGS of C. acnes isolated colonies showed that all the revision-surgery isolates clustered near to the corresponding primary-surgery isolates compared to the other independent bacterial colonies. (99.89% of similarity). C. acnes present at the end of the primary surgery can be the cause of early or delayed periprosthetic joint infections in shoulder arthroplasty.
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Affiliation(s)
- Carlos Torrens
- Orthopaedic Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Beatriz Bellosillo
- Pathology Department, Hospital del Mar, Barcelona, Spain.,Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Joan Gibert
- Pathology Department, Hospital del Mar, Barcelona, Spain.,Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Albert Alier
- Orthopaedic Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Fernando Santana
- Orthopaedic Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Nuria Prim
- Microbiology Service, Laboratori de Referència de Catalunya, Hospital del Mar, Barcelona, Spain
| | - Stéphane Corvec
- Service de Bactériologie Et Des Contrôles Microbiologiques, Université de Nantes, CHU Nantes, CRCINA U1232, 44000, Nantes, France
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Huang TB, Pena Diaz AM, Faber KJ, Athwal GS, Woolman M, Nygard K, Keenliside L, O'Gorman DB. Development of a 3D Bioartificial Shoulder Joint Implant Mimetic of Periprosthetic Joint Infection. Tissue Eng Part A 2021; 28:175-183. [PMID: 34309434 DOI: 10.1089/ten.tea.2021.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-surgical infections of the shoulder joint involving Cutibacterium acnes are difficult to diagnose and manage. Despite the devastating clinical complications and costly healthcare burden of joint infections, the scarcity of joint infection models was identified as an unmet need by the 2019 International Consensus on Orthopedic Infections. In this study, we have developed a novel 3D shoulder joint implant mimetic (S-JIM) that includes a surgical metal surface and supports a co-culture of C. acnes and patient-derived shoulder capsule fibroblasts. Our findings indicate the S-JIM can generate a near anaerobic interior environment that allows for C. acnes proliferation and elicit fibroblast cell lysis responses that are consistent with clinical reports of tissue necrosis. Using the S-JIM, we provided proof-of-concept for the use of mass spectrometry in real-time detection of C. acnes joint infections during surgery. The S-JIM is the first in vitro cell culture-based biomimetic of periprosthetic joint infection that provides a preclinical method for the rapid and reliable testing of novel anti-PJI interventions.
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Affiliation(s)
- Tony B Huang
- University of Western Ontario, 6221, Department of Biochemistry, London, Ontario, Canada.,Lawson Health Research Institute, 151158, McFarlane Hand and Upper Limb Centre, London, Ontario, Canada;
| | - Ana M Pena Diaz
- Lawson Health Research Institute, 151158, McFarlane Hand and Upper Limb Centre, London, Ontario, Canada;
| | - Kenneth J Faber
- Lawson Health Research Institute, 151158, McFarlane Hand and Upper Limb Centre, London, Ontario, Canada.,University of Western Ontario, 6221, Department of Surgery, London, Ontario, Canada;
| | - George S Athwal
- Lawson Health Research Institute, 151158, McFarlane Hand and Upper Limb Centre, London, Ontario, Canada.,University of Western Ontario, 6221, Department of Surgery, London, Ontario, Canada;
| | - Michael Woolman
- University of Toronto, 7938, Department of Medical Biophysics, Toronto, Ontario, Canada;
| | - Karen Nygard
- University of Western Ontario, 6221, Biotron Experimental Climate Change Research Centre, London, Ontario, Canada;
| | - Lynn Keenliside
- Lawson Health Research Institute, 151158, Lawson Imaging, London, Ontario, Canada;
| | - David B O'Gorman
- University of Western Ontario, 6221, Department of Biochemistry, London, Ontario, Canada.,Lawson Health Research Institute, 151158, McFarlane Hand and Upper Limb Centre, London, Ontario, Canada;
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22
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Kusejko K, Auñón Á, Jost B, Natividad B, Strahm C, Thurnheer C, Pablo-Marcos D, Slama D, Scanferla G, Uckay I, Waldmann I, Esteban J, Lora-Tamayo J, Clauss M, Fernandez-Sampedro M, Wouthuyzen-Bakker M, Ferrari MC, Gassmann N, Sendi P, Jent P, Morand PC, Vijayvargiya P, Trebše R, Patel R, Kouyos RD, Corvec S, Kramer TS, Stadelmann VA, Achermann Y. The Impact of Surgical Strategy and Rifampin on Treatment Outcome in Cutibacterium Periprosthetic Joint Infections. Clin Infect Dis 2021; 72:e1064-e1073. [PMID: 33300545 DOI: 10.1093/cid/ciaa1839] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cutibacterium species are common pathogens in periprosthetic joint infections (PJI). These infections are often treated with β-lactams or clindamycin as monotherapy, or in combination with rifampin. Clinical evidence supporting the value of adding rifampin for treatment of Cutibacterium PJI is lacking. METHODS In this multicenter retrospective study, we evaluated patients with Cutibacterium PJI and a minimal follow-up of 12 months. The primary endpoint was clinical success, defined by the absence of infection relapse or new infection. We used Fisher's exact tests and Cox proportional hazards models to analyze the effect of rifampin and other factors on clinical success after PJI. RESULTS We included 187 patients (72.2% male, median age 67 years) with a median follow-up of 36 months. The surgical intervention was a 2-stage exchange in 95 (50.8%), 1-stage exchange in 51 (27.3%), debridement and implant retention (DAIR) in 34 (18.2%), and explantation without reimplantation in 7 (3.7%) patients. Rifampin was included in the antibiotic regimen in 81 (43.3%) cases. Infection relapse occurred in 28 (15.0%), and new infection in 13 (7.0%) cases. In the time-to-event analysis, DAIR (adjusted hazard ratio [HR] = 2.15, P = .03) and antibiotic treatment over 6 weeks (adjusted HR = 0.29, P = .0002) significantly influenced treatment failure. We observed a tentative evidence for a beneficial effect of adding rifampin to the antibiotic treatment-though not statistically significant for treatment failure (adjusted HR = 0.5, P = .07) and not for relapses (adjusted HR = 0.5, P = .10). CONCLUSIONS We conclude that a rifampin combination is not markedly superior in Cutibacterium PJI, but a dedicated prospective multicenter study is needed.
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Affiliation(s)
- Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Benito Natividad
- Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carol Strahm
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christine Thurnheer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Giulia Scanferla
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Ilker Uckay
- University Hospital Zurich, Orthopedic University Hospital Balgrist, Zurich, Switzerland
| | - Isabelle Waldmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Martin Clauss
- Center for Musculoskeletal Infections, Department for Orthopedics and Trauma Surgery, University Hospital Basel, University of Basel, Basel, and Kantonsspital Baselland, Liestal, Switzerland
| | | | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Matteo Carlo Ferrari
- Humanitas Clinical and Research Center -IRCCS and Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Natalie Gassmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Parham Sendi
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Jent
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Rihard Trebše
- Medical Faculty University of Ljubljana, Valdoltra Orthopedic Hospital, Ankaran, Slovenia
| | | | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Stéphane Corvec
- Service de Bactériologie- Hygiène hospitalière, CRCINA, Université de Nantes, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Tobias Siegfried Kramer
- Charité Universitätsmedizin Berlin, Berlin, Germany; Evangelisches Waldkrankenhaus Spandau, Berlin, Germany LADR Zentrallabor Dr. Kramer und Kollegen, Geesthacht, Germany
| | | | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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23
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Foster AL, Cutbush K, Ezure Y, Schuetz MA, Crawford R, Paterson DL. Cutibacterium acnes in shoulder surgery: a scoping review of strategies for prevention, diagnosis, and treatment. J Shoulder Elbow Surg 2021; 30:1410-1422. [PMID: 33373684 DOI: 10.1016/j.jse.2020.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cutibacterium acnes is a commensal, gram-positive, facultatively anaerobic bacillus that resides in the dermis. Historically thought to be a contaminant when identified on cultured specimens, recent advances in diagnostic technology have now implicated it as the most common organism responsible for postoperative shoulder infections. Despite a recognition of the role of this organism and a significant research interest in recent years, there is clear lack of consensus guideline on strategies to prevent, diagnose, and treat postoperative shoulder infection. METHOD The electronic databases PubMed, MEDLINE, CINAHL, Scopus, and Web of Science were searched in March 2020. All experimental and nonexperimental studies that investigate C acnes in shoulder surgery were included. Inclusion was limited to articles published after 2000 and written in English; reviews, gray literature, or abstracts were excluded. A total of 70 studies were included in this review. This scoping review was performed in accordance with the Extended Preferred Reporting Items of Systematic Reviews and Meta-Analyses Statement for Scoping Reviews (PRISMA-ScR). RESULTS Standard surgical prophylactic regimens such as intravenous antibiotics and topical chlorhexidine are ineffective at removing C acnes from the deep layer of the dermis, and there is a shift toward using topical benzoyl peroxide with significantly improved efficacy. An improved understanding of the bacteria has demonstrated that a prolonged culture time of up to 14 days is needed, especially in cases of established infection. Advances in diagnostics such as sonication and molecular-based testing are promising. Although usually thought to be susceptible to a broad range of antibiotics, resistance is emerging to clindamycin. An improved understanding of its ability to form a biofilm highlights the difficulty in treating an established infection. CONCLUSION The role of C acnes causing postoperative infection following shoulder surgery is being increasingly recognized. Strategies for prevention, diagnosis, and treatment have been outlined from both an antimicrobial and surgical perspective. A number of these strategies are emerging and require further research to demonstrate efficacy before implementation into clinical guidelines.
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Affiliation(s)
- Andrew L Foster
- Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kenneth Cutbush
- Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Yukiko Ezure
- University of Queensland Centre for Clinical Research, RBWH Campus, Brisbane, QLD, Australia
| | - Michael A Schuetz
- Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Ross Crawford
- Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, RBWH Campus, Brisbane, QLD, Australia.
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24
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Brüggemann H, Salar-Vidal L, Gollnick HPM, Lood R. A Janus-Faced Bacterium: Host-Beneficial and -Detrimental Roles of Cutibacterium acnes. Front Microbiol 2021; 12:673845. [PMID: 34135880 PMCID: PMC8200545 DOI: 10.3389/fmicb.2021.673845] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/29/2021] [Indexed: 12/18/2022] Open
Abstract
The bacterial species Cutibacterium acnes (formerly known as Propionibacterium acnes) is tightly associated with humans. It is the dominant bacterium in sebaceous regions of the human skin, where it preferentially colonizes the pilosebaceous unit. Multiple strains of C. acnes that belong to phylogenetically distinct types can co-exist. In this review we summarize and discuss the current knowledge of C. acnes regarding bacterial properties and traits that allow host colonization and play major roles in host-bacterium interactions and also regarding the host responses that C. acnes can trigger. These responses can have beneficial or detrimental consequences for the host. In the first part of the review, we highlight and critically review disease associations of C. acnes, in particular acne vulgaris, implant-associated infections and native infections. Here, we also analyse the current evidence for a direct or indirect role of a C. acnes-related dysbiosis in disease development or progression, i.e., reduced C. acnes strain diversity and/or the predominance of a certain phylotype. In the second part of the review, we highlight historical and recent findings demonstrating beneficial aspects of colonization by C. acnes such as colonization resistance, immune system interactions, and oxidant protection, and discuss the molecular mechanisms behind these effects. This new insight led to efforts in skin microbiota manipulation, such as the use of C. acnes strains as probiotic options to treat skin disorders.
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Affiliation(s)
| | - Llanos Salar-Vidal
- Department of Clinical Microbiology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Harald P. M. Gollnick
- Department of Dermatology and Venerology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Rolf Lood
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
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25
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Vilchez HH, Escudero-Sanchez R, Fernandez-Sampedro M, Murillo O, Auñón Á, Rodríguez-Pardo D, Jover-Sáenz A, del Toro MD, Rico A, Falgueras L, Praena-Segovia J, Guío L, Iribarren JA, Lora-Tamayo J, Benito N, Morata L, Ramirez A, Riera M. Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study. Antibiotics (Basel) 2021; 10:antibiotics10050475. [PMID: 33919103 PMCID: PMC8143127 DOI: 10.3390/antibiotics10050475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.
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Affiliation(s)
- Helem H. Vilchez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
- Correspondence: ; Tel.: +34-653419331
| | - Rosa Escudero-Sanchez
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, 39008 Cantabria, Spain;
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | - Álvaro Auñón
- Bone and Joint Infection Unit, Department of Orthopaedic Surgery, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Alfredo Jover-Sáenz
- Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain;
| | - Mª Dolores del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena CSIC, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, 41009 Sevilla, Spain;
| | - Alicia Rico
- Infectious Diseases Unit and Clinical Microbiology, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Luis Falgueras
- Infectious Diseases Department, Corporació Sanitària Parc Taulí, 08208 Barcelona, Spain;
| | - Julia Praena-Segovia
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, 41013 Sevilla, Spain;
| | - Laura Guío
- Infectious Diseases Department, Hospital Universitario Cruces, 48903 Vizcaya, Spain;
| | - José A. Iribarren
- Infectious Diseases Department, Hospital Universitario Donostia, Instituto BioDonostia, 20014 San Sebastián, Spain;
| | - Jaime Lora-Tamayo
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre “i + 12”, 28041 Madrid, Spain;
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d’Investigació Biomèdica Sant Pau, Departament of Medicine, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Antonio Ramirez
- Microbiologic Department, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Melchor Riera
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
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26
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Lee YH, Chiu CC, Chang CY. Engineered photo-chemical therapeutic nanocomposites provide effective antibiofilm and microbicidal activities against bacterial infections in porous devices. Biomater Sci 2021; 9:1739-1753. [PMID: 33432933 DOI: 10.1039/d0bm01814g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Today, prosthetic joint infection (PJI) is still a relatively rare but devastating complication following total hip and/or knee arthroplasty. The treatment of PJI is difficult due to a number of obstacles, such as microbial drug resistance, biofilm protection, and insufficient immune activity, which dramatically diminish the cure rate of PJI to <50%. To efficiently eradicate the bacteria hiding in the implant, photo-chemical joint antibacterial therapeutics based on indocyanine green (ICG) and rifampicin (RIF) co-loaded PLGA nanoparticles (IRPNPs) were developed in this study. The IRPNPs were first characterized as a spherical nanostructure with a size of 266 ± 18.2 nm and a surface charge of -28 ± 1.6 mV. In comparison with freely dissolved ICG, the IRPNPs may confer enhanced thermal stability to the encapsulated ICG and are able to provide a comparable hyperthermic effect and increased production of singlet oxygen under 808 nm near infrared (NIR) exposure with an intensity of 6 W cm-2. Based on the spectrophotometric analysis, the IRPNPs with ≥20-/3.52 μM ICG/RIF were able to provide remarkable antibiofilm and antimicrobial effects against bacteria in a porous silicon bead upon NIR exposure in vitro. Through the analysis of the microbial population index in an animal study, ≥70% Staphylococcus capitis subsp. urealyticus grown in a porous silicon bead in vivo can be successfully eliminated without organ damage or inflammatory lesions around the implant by using IRPNPs + NIR irradiation every 72 h for 9 days. The resulting bactericidal efficacy was approximately three-fold higher than that resulting from using an equal amount of free RIF alone. Taken together, we anticipate that IRPNP-mediated photochemotherapy can serve as a feasible antibacterial approach for PJI treatment in the clinic.
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Affiliation(s)
- Yu-Hsiang Lee
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan, Republic of China. and Department of Chemical and Materials Engineering, National Central University, Taoyuan City, Taiwan, Republic of China
| | - Chen-Chih Chiu
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan, Republic of China.
| | - Chin-Yuan Chang
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City, Taiwan, Republic of China.
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27
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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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28
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Budge MD, Koch JA, Mandell JB, Cappellini AJ, Orr S, Patel S, Ma D, Nourie O, Brothers KM, Urish KL. The In Vitro Efficacy of Doxycycline over Vancomycin and Penicillin in the Elimination of Cutibacterium Acnes Biofilm. ANTIMICROBIAL COMBINATION DEVICES 2020; STP1630:53-64. [PMID: 35529525 PMCID: PMC9070841 DOI: 10.1520/stp163020200019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cutibacterium acnes (formerly Propionibacterium acnes) is a significant pathogen in periprosthetic joint infections (PJIs) in total shoulder arthroplasty. Poor outcomes seen in PJIs are due to the established C. acnes bacterial biofilms. The prolonged nature of C. acnes infections makes them difficult to treat with antibiotics. The goal of this study was to determine the relative efficacy of vancomycin compared with penicillin and doxycycline against planktonic and mature biofilms. Clinical isolates from PJI patients as well as a laboratory strain of C. acnes were tested. Planktonic minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) were obtained using modified clinical laboratory standard index assays. Biofilm MICs and MBCs were also obtained. The MIC was determined for both using the PrestoBlue viability stain. The MBC was determined using differential reinforced clostridial medium agar plates for colony-forming unit analysis. Using the PrestoBlue viability reagent, the planktonic MIC values for vancomycin were significantly higher than doxycycline. Across 10 strains of C. acnes, all three antibiotics had decreased efficacy when comparing planktonic and biofilm cultures. Although effective antibiotic doses ranged from 1 to 1,000 μg/mL, only doxycycline achieved inhibitory and bactericidal concentrations in all tested strains. Penicillin failed to achieve the minimum biofilm inhibitory concentration (MBIC) in 60% of tested strains, whereas vancomycin failed in 80% of tested strains. Penicillin, doxycycline, and vancomycin have similar abilities in inhibiting C. acnes growth planktonically. The MBIC for doxycycline was within the clinical dosing range, suggesting C. acnes biofilm offers minimal tolerance to these antibiotics. The MBIC for penicillin was within clinical dosing ranges in only 60% of trials, suggesting the relative tolerance of C. acnes to penicillin. The minimum biofilm bactericidal concentration (MBBC) of doxycycline showed efficacy in 90% of trials, whereas penicillin and vancomycin achieved MBBC in 15% of samples.
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Affiliation(s)
- Matthew D Budge
- NW Perrnanente, 5125 Skyline Rd. S., Salem, OR 97306-9427, USA
| | - John A Koch
- NW Perrnanente, 5125 Skyline Rd. S., Salem, OR 97306-9427, USA
- Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, 100 Technology Dr., Pittsburgh, PA 15219, USA
| | - Jonathan B Mandell
- Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, 100 Technology Dr., Pittsburgh, PA 15219, USA
| | - Alex J Cappellini
- Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, 100 Technology Dr., Pittsburgh, PA 15219, USA
| | - Sara Orr
- Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, 100 Technology Dr., Pittsburgh, PA 15219, USA
| | - Samik Patel
- Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, 100 Technology Dr., Pittsburgh, PA 15219, USA
| | - Dongzhu Ma
- Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, 100 Technology Dr., Pittsburgh, PA 15219, USA
| | - Olivia Nourie
- NW Perrnanente, 5125 Skyline Rd. S., Salem, OR 97306-9427, USA
| | - Kimberly M Brothers
- Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, 100 Technology Dr., Pittsburgh, PA 15219, USA
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, MageeWomens Hospital of the University of Pittsburgh Medical Center, 300 Halket St., Pittsburgh, PA 15213, USA; and Dept. of Orthopaedic Surgery, Dept. of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh, 100 Technology Dr., Pittsburgh, PA 15219, USA
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Schmid B, Hausmann O, Hitzl W, Achermann Y, Wuertz-Kozak K. The Role of Cutibacterium acnes in Intervertebral Disc Inflammation. Biomedicines 2020; 8:biomedicines8070186. [PMID: 32629986 PMCID: PMC7400222 DOI: 10.3390/biomedicines8070186] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Recently, the role of infection of the intervertebral disc (IVD) with Cutibacterium acnes (C. acnes) as a contributor to disc-related low back pain (LBP) has been discussed. The aim of this study was to investigate whether and how C. acnes contributes to the inflammatory processes during IVD disease. The prevalence of C. acnes infection in human IVD tissue was determined by aerobic and anaerobic culture. Thereafter, primary human IVD cells were infected with a reference and a clinical C. acnes strain and analyzed for pro-inflammatory markers (gene/protein level). In a subsequent experiment, the involvement of the Toll-like receptor (TLR) pathway was investigated by co-treatment with sparstolonin B, a TLR2/4 inhibitor. We detected C. acnes in 10% of IVD biopsies (with either herniation or degeneration). Stimulating IVD cells with both C. acnes strains strongly and significantly upregulated expression of Interleukin (IL)-1β, IL-6, IL-8, and inducible nitric oxide synthase (iNOS). IL-6, cyclooxygenase (COX)-2, and iNOS expression was reduced upon TLR2/4 inhibition in 3 out of 5 donors, whereby responders and non-responders could not be differentiated by their basal TLR2 or TLR4 expression levels. We demonstrate that exposure of IVD cells to C. acnes induces an inflammatory response that may contribute to the development of discogenic LBP by involving TLR2/4 activation, yet only in a subgroup of patients. Whether the same response will be observed in vivo and where lower inoculums are present remains to be proven in future studies.
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Affiliation(s)
- Bettina Schmid
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland;
- Faculty of Science, University of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| | - Oliver Hausmann
- Neuro- and Spine Centre, Klinik St. Anna, St. Anna Street 32, 6006 Lucerne, Switzerland;
- Department of Neurosurgery, Inselspital Berne, University of Berne, Murtenstrasse 11, 3010 Berne, Switzerland
- CABMM Center for Applied Biotechnology and Molecular Medicine, University of Zurich, 8057 Zurich, Switzerland;
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Strubergasse 20, 5020 Salzburg, Austria;
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, 2020 Salzburg, Austria
| | - Yvonne Achermann
- CABMM Center for Applied Biotechnology and Molecular Medicine, University of Zurich, 8057 Zurich, Switzerland;
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Karin Wuertz-Kozak
- CABMM Center for Applied Biotechnology and Molecular Medicine, University of Zurich, 8057 Zurich, Switzerland;
- Department of Biomedical Engineering, Rochester Institute of Technology (RIT), 106 Lomb Memorial Dr., Rochester, NY 14623, USA
- Institute for Biomechanics, D-HEST, ETH Zurich, Hönggerbergring 64, 8093 Zurich, Switzerland
- Spine Center, Schön Clinic Munich Harlaching (Academic Teaching Hospital and Spine Research Institute of the Paracelsus Medical University Salzburg), Harlachinger Str. 51, 81547 Munich, Germany
- Correspondence: or ; Tel.: +1585-475-7355
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Hsiao KH, Huang CM, Lee YH. Novel Rifampicin and Indocyanine Green Co-Loaded Perfluorocarbon Nanodroplets Provide Effective In Vivo Photo-Chemo-Probiotic Antimicrobility against Pathogen of Acne Vulgaris Cutibacterium acnes. NANOMATERIALS 2020; 10:nano10061095. [PMID: 32492862 PMCID: PMC7353360 DOI: 10.3390/nano10061095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 02/05/2023]
Abstract
Acne vulgaris is one of the most prevalent dermatological diseases among adolescents and is often associated with overgrowth of Cutibacterium acnes (C. acnes) in the pilosebaceous units. In this study, we aimed to develop novel rifampicin (RIF) and indocyanine green (ICG) co-loaded perfluorocarbon nanodroplets named RIPNDs which can simultaneously provide photo-, chemo-, and probiotic-antimicrobility, and explore their efficacy in treatment of C. acnes in vitro and in vivo. The RIPNDs were first characterized as being spherical in shape, with a size of 238.6 ± 7.51 nm and surface charge of -22.3 ± 3.5 mV. Then, the optimal dosages of Staphylococcus epidermidis-produced fermentation product medium (FPM) and RIPND were determined as 25% (v/v) and [RIF]/[ICG] = 3.8/20 μM, respectively, based on the analyses of inhibition zone and cytotoxicity in vitro. Through the in vivo study using C. acnes-inoculated mice, our data showed that the group treated with FPM followed by RIPNDs + near infrared (NIR) irradiation obtained the least granulocytes/macrophage-inflammatory protein 2 expression level in the epidermis, and showed a significantly lower microbial colony population compared to the groups treated with equal amount of RIF, FPM, RIPNDs, and/or combination of the above ± NIR. These results indicated that the RIPND-mediated photo-chemo-probiotic therapeutics was indeed able to rapidly suppress inflammatory response of the skin and provide a robust antibacterial effect against C. acnes with limited use of antibiotics. Taken altogether, we anticipate that the RIPND is highly potential for use in the clinical treatment of acne vulgaris.
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Affiliation(s)
- Kuang-Hung Hsiao
- Department of Biomedical Sciences and Engineering, National Central University. No. 300, Jhongda Rd., Taoyuan City 32001, Taiwan;
| | - Chun-Ming Huang
- Department of Biomedical Sciences and Engineering, National Central University. No. 300, Jhongda Rd., Taoyuan City 32001, Taiwan;
- Department of Dermatology, University of California, San Diego, CA 92093, USA
- Correspondence: (C.-M.H.); (Y.-H.L.); Tel.: +886-3-422-7151 (ext. 36101) (C.-M.H.); Tel.: +886-3-422-7151 (ext. 27755) (Y.-H.L.); Fax: +886-3-280-4627 (C.-M.H. & Y.-H.L.)
| | - Yu-Hsiang Lee
- Department of Biomedical Sciences and Engineering, National Central University. No. 300, Jhongda Rd., Taoyuan City 32001, Taiwan;
- Department of Chemical and Materials Engineering, National Central University, Taoyuan City 32001, Taiwan
- Correspondence: (C.-M.H.); (Y.-H.L.); Tel.: +886-3-422-7151 (ext. 36101) (C.-M.H.); Tel.: +886-3-422-7151 (ext. 27755) (Y.-H.L.); Fax: +886-3-280-4627 (C.-M.H. & Y.-H.L.)
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Tsikopoulos K, Drago L, Koutras G, Givissis P, Vagdatli E, Soukiouroglou P, Papaioannidou P. Radial Extracorporeal Shock Wave Therapy Against Cutibacterium acnes Implant-Associated Infections: An in Vitro Trial. Microorganisms 2020; 8:E743. [PMID: 32429267 PMCID: PMC7285346 DOI: 10.3390/microorganisms8050743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Antibiotic management of low-virulent implant-associated infections induced by Cutibacterium acnes may be compromised by multi-drug resistance development, side effects, and increased cost. Therefore, we sought to assess the effects of shock wave therapy against the above pathogen using an in vitro model of infection. METHODS We used a total of 120 roughened titanium alloy disks, simulating orthopedic biomaterials, to assess the results of radial extracorporeal shock wave therapy (rESWT) against C. acnes (ATCC 11827) biofilms relative to untreated control. In particular, we considered 1.6 to 2.5 Bar with a frequency ranging from 8-11 Hz and 95 to 143 impulses per disk to investigate the antibacterial effect of rESWT against C. acnes planktonic (free-floating) and biofilm forms. RESULTS Planktonic bacteria load diminished by 54% compared to untreated control after a 1.8-bar setting with a frequency of 8 Hz and 95 impulses was applied (median absorbance (MA) for intervention vs. control groups was 0.9245 (IQR= 0.888 to 0.104) vs. 0.7705 (IQR = 0.712 to 0.864), respectively, p = 0.001). Likewise, a statistically significant reduction in the amount of biofilm relative to untreated control was documented when the above setting was considered (MA for treatment vs biofilm control groups was 0.244 (IQR= 0.215-0.282) and 0.298 (IQR = 0.247-0.307), respectively, p = 0.033). CONCLUSION A 50% biofilm eradication was documented following application of low-pressure and low-frequency radial shock waves, so rESWT could be investigated as an adjuvant treatment to antibiotics, but it cannot be recommended as a standalone treatment against device-associated infections induced by C. ances.
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Affiliation(s)
- Konstantinos Tsikopoulos
- 1st Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Lorenzo Drago
- Laboratory of Clinical Microbiology, Department of Biochemical Sciences for Health, University of Milan, 20133 Milan, Italy;
| | - Georgios Koutras
- Department of Physical Therapy, Technological Education Institute of Thessaloniki, 57400 Sindos, Greece;
| | - Panagiotis Givissis
- 1st Orthopaedic Department of Aristotle University, G. Papanikolaou General Hospital, Exohi, 57010 Thessaloniki, Greece;
| | - Eleni Vagdatli
- Laboratory of Microbiology, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.V.); (P.S.)
| | - Prodromos Soukiouroglou
- Laboratory of Microbiology, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.V.); (P.S.)
| | - Paraskevi Papaioannidou
- 1st Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Sigmund IK, Renz N, Feihl S, Morgenstern C, Cabric S, Trampuz A. Value of multiplex PCR for detection of antimicrobial resistance in samples retrieved from patients with orthopaedic infections. BMC Microbiol 2020; 20:88. [PMID: 32290833 PMCID: PMC7155317 DOI: 10.1186/s12866-020-01741-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 03/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background The performance of multiplex PCR (mPCR) for detection of antimicrobial resistance from clinical isolates is unknown. We assessed the ability of mPCR to analyse resistance genes directly from clinical samples. Patients with orthopedic infections were prospectively included. Phenotypical and genotypical resistance was evaluated in clinical samples (synovial and sonication fluid) where identical pathogens were identified by culture and mPCR. Result A total of 94 samples were analysed, including 60 sonication fluid and 34 synovial fluid samples. For coagulase-negative staphylococcus strains, mPCR detected resistance to oxacillin in 10 of 23 isolates (44%) and to rifampin in none of 6 isolates. For S. aureus isolates, detection rate of oxacillin and rifampin-resistance was 100% (2/2 and 1/1, respectively). Fluoroquinolone-resistance was confirmed by mPCR in all 3 isolates of Enterobacteriaceae, in enterococci resistance to aminoglycoside-high level was detected in 1 of 3 isolates (33%) and in streptococci resistance to macrolides/lincosamides in none of 2 isolates. The overall sensitivity for different pathogens and antimicrobials was 46% and specificity 95%, the median concordance was 80% (range, 57–100%). Full agreement was observed for oxacillin in S. aureus, vancomycin in enterococci, carbapenems/cephalosporins in Enterobacteriaceae and rifampin in Cutibacterium species. Conclusion The overall sensitivity for detection of antimicrobial resistance by mPCR directly from clinical samples was low. False-negative mPCR results occurred mainly in coagulase-negative staphylococci, especially for oxacillin and rifampin. However, the specificity of mPCR was high and a positive result reliably predicted antimicrobial resistance. Including universal primers in the PCR test assay may improve the detection rate but requires additional sequencing step. Trial registration www.clinicaltrials.gov No. NCT02530229, registered at 21 August 2015 (retrospectively registered).
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Affiliation(s)
- Irene Katharina Sigmund
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany.,Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Nora Renz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany
| | - Susanne Feihl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Morgenstern
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany
| | - Sabrina Cabric
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany.,Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany. .,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Föhrer Strasse 15, 13353, Berlin, Germany.
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Karbysheva S, Di Luca M, Butini ME, Winkler T, Schütz M, Trampuz A. Comparison of sonication with chemical biofilm dislodgement methods using chelating and reducing agents: Implications for the microbiological diagnosis of implant associated infection. PLoS One 2020; 15:e0231389. [PMID: 32267888 PMCID: PMC7141651 DOI: 10.1371/journal.pone.0231389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/23/2020] [Indexed: 01/23/2023] Open
Abstract
The diagnosis of implant-associated infections is hampered due to microbial adherence and biofilm formation on the implant surface. Sonication of explanted devices was shown to improve the microbiological diagnosis by physical removal of biofilms. Recently, chemical agents have been investigated for biofilm dislodgement such as the chelating agent ethylenediaminetetraacetic acid (EDTA) and the reducing agent dithiothreitol (DTT). We compared the activity of chemical methods for biofilm dislodgement to sonication in an established in vitro model of artificial biofilm. Biofilm-producing laboratory strains of Staphylococcus epidermidis (ATCC 35984), S. aureus (ATCC 43300), E. coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 53278) were used. After 3 days of biofilm formation, porous glass beads were exposed to control (0.9% NaCl), sonication or chemical agents. Quantitative and qualitative biofilm analyses were performed by colony counting, isothermal microcalorimetry and scanning electron microscopy. Recovered colony counts after treatment with EDTA and DTT were similar to those after exposure to 0.9% NaCl for biofilms of S. epidermidis (6.3 and 6.1 vs. 6.0 log10 CFU/mL, S. aureus (6.4 and 6.3 vs. 6.3 log10 CFU/mL), E. coli (5.2 and 5.1 vs. 5.1 log10 CFU/mL and P. aeruginosa (5.1 and 5.2 vs. 5.0 log10 CFU/mL, respectively). In contrast, with sonication higher CFU counts were detected with all tested microorganisms (7.5, 7.3, 6.2 and 6.5 log10 CFU/mL, respectively) (p <0.05). Concordant results were observed with isothermal microcalorimetry and scanning electron microscopy. In conclusion, sonication is superior to both tested chemical methods (EDTA and DTT) for dislodgement of S. epidermidis, S. aureus, E. coli and P. aeruginosa biofilms. Future studies may evaluate potential additive effect of chemical dislodgement to sonication.
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Affiliation(s)
- Svetlana Karbysheva
- Center for Musculoskeletal Surgery, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Berlin, Germany
| | - Mariagrazia Di Luca
- Center for Musculoskeletal Surgery, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Berlin, Germany
| | - Maria Eugenia Butini
- Center for Musculoskeletal Surgery, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Berlin, Germany
| | - Michael Schütz
- Department of Orthopaedics and Trauma, Jamieson Trauma Institute, Queensland University of Technology, Brisbane, Australia
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Berlin, Germany
- * E-mail:
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Gellert M, Hardt S, Köder K, Renz N, Perka C, Trampuz A. Biofilm-active antibiotic treatment improves the outcome of knee periprosthetic joint infection: Results from a 6-year prospective cohort study. Int J Antimicrob Agents 2020; 55:105904. [DOI: 10.1016/j.ijantimicag.2020.105904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 01/05/2020] [Accepted: 01/11/2020] [Indexed: 01/03/2023]
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Couture A, Lavergne V, Sandman E, Leduc JM, Benoit B, Leduc S, Rouleau DM. Calcium sulphate mixed with antibiotics does not decrease efficacy against Cutibacterium acnes (formerly Propionibacterium acnes), in vitro study. J Orthop 2020; 19:138-142. [PMID: 32025121 DOI: 10.1016/j.jor.2019.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022] Open
Abstract
Background This study explored the in vitro efficacy of antibiotics mixed with calcium sulfate (ACS) against Cutibacterium acnes (C. acnes). Methods C. acnes isolates from orthopaedic infection sites were tested for antimicrobial susceptibility with ACS. Minimal inhibitory concentrations (MIC) were determined with a gradient diffusion method (Etest® strips). Results When tested with Etest®, all 22 isolates were susceptible to penicillin, ceftriaxone, vancomycin, and two were resistant to clindamycin (MICs of 4 and 8 mg/L). Penicillin and rifampin had the largest inhibition zone diameters. Conclusions Antibiotics retained activity against C. acnes when mixed with calcium sulfate.
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Affiliation(s)
- Anne Couture
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Valéry Lavergne
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Emilie Sandman
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Jean-Michel Leduc
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Benoit Benoit
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Stéphane Leduc
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
| | - Dominique M Rouleau
- Université de Montréal, 2900 Boul., Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Hôpital Du Sacré-Cœur, Montréal, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
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Lin ZX, Steed LL, Marculescu CE, Slone HS, Woolf SK. Cutibacterium acnes Infection in Orthopedics: Microbiology, Clinical Findings, Diagnostic Strategies, and Management. Orthopedics 2020; 43:52-61. [PMID: 31958341 DOI: 10.3928/01477447-20191213-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/30/2019] [Indexed: 02/03/2023]
Abstract
Cutibacterium (formerly called Propionibacterium) acnes is a human skin flora often implicated in orthopedic infections. The unique characteristics of this microorganism make the diagnosis of infection difficult. The diagnosis often is made based on clinical evidence, radiographic signs, and laboratory and/or surgical findings combined. Treatment often involves both pharmacologic and surgical methods. In addition, formation of biofilms and increased resistance to drugs exhibited by the microorganism can require combined antimicrobial therapy. Prophylactic measures are particularly important, but no single method has been shown to fully eliminate the risk of C acnes infections. Previous reports have focused on C acnes infections involving surgical implants or after certain orthopedic procedures, particularly in the shoulder and spine. This article reviews current clinical, diagnostic, and treatment principles for C acnes in orthopedics in general. [Orthopedics. 2020; 43(1):52-61.].
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37
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Depypere M, Kuehl R, Metsemakers WJ, Senneville E, McNally MA, Obremskey WT, Zimmerli W, Atkins BL, Trampuz A. Recommendations for Systemic Antimicrobial Therapy in Fracture-Related Infection: A Consensus From an International Expert Group. J Orthop Trauma 2020; 34:30-41. [PMID: 31567902 PMCID: PMC6903362 DOI: 10.1097/bot.0000000000001626] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 02/02/2023]
Abstract
Fracture-related infection (FRI) is a major complication in musculoskeletal trauma and one of the leading causes of morbidity. Standardization of general treatment strategies for FRI has been poor. One of the reasons is the heterogeneity in this patient population, including various anatomical locations, multiple fracture patterns, different degrees of soft-tissue injury, and different patient conditions. This variability makes treatment complex and hard to standardize. As these infections are biofilm-related, surgery remains the cornerstone of treatment, and this entails multiple key aspects (eg, fracture fixation, tissue sampling, debridement, and soft-tissue management). Another important aspect, which is sometimes less familiar to the orthopaedic trauma surgeon, is systemic antimicrobial therapy. The aim of this article is to summarize the available evidence and provide recommendations for systemic antimicrobial therapy with respect to FRI, based on the most recent literature combined with expert opinion. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Richard Kuehl
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | | | - Eric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital, University of Lille, Lille, France
| | - Martin A. McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - William T. Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Werner Zimmerli
- Kantonsspital Baselland, Interdisciplinary Unit for Orthopedic Infections, Liestal, Switzerland; and
| | - Bridget L. Atkins
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Schröder ML, Angrisani N, Fadeeva E, Hegermann J, Reifenrath J. Laser-structured spike surface shows great bone integrative properties despite infection in vivo. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 109:110573. [PMID: 32228937 DOI: 10.1016/j.msec.2019.110573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/25/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Implant associated infections can result in devastating consequences for patients. One major cause is the formation of bacterial biofilms, which result in increased resistance against antimicrobial therapeutics. A reduction of implant associated infections can be achieved by functionalization of implant surfaces. The generation of three dimensional surface structures by femtosecond laser ablation is one method to fabricate bacterial repellent large scaled surfaces without altering the material chemical composition. The challenge is to reduce bacterial growth while improving cellular ongrowth. For this purpose, spike structures were created as small as possible by used fabrication method on cubic Ti90/Al6/V4-rods and their effectiveness against bacterial colonization was compared to unstructured Ti90/Al6/V4-rods. Rods were implanted in the rat tibia and infected intraoperatively with 103 CFU of Staphylococcus aureus. Besides clinical behaviour and lameness, the vital bacterial biomass, morphological appearance and the volume of eukaryotic cells were determined on the implant surface after 21 days. Bone alterations were examined by radiological and histological techniques. Unexpectedly, the laser-structured implants did not show a lower bacterial load on the implant surface and less severe infection related bone and tissue alterations compared to the group without structuring. Simultaneously, a better bony integration and a higher cellular colonization with eukaryotic cells was detected on the laser-structured implants. These findings don't support the previous in vitro results. Nevertheless, the strong integration into the bone is a powerful argument for further surface modifications focussing on the improvement of the antibacterial effect. Additionally, our results underline the need for in vivo testing of new materials prior to clinical use.
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Affiliation(s)
- M-L Schröder
- Hannover Medical School, Clinic for Orthopedic Surgery, Anna-von-Borries Str. 1-9, 30625 Hannover, Germany; University of Veterinary Medicine Hannover, Foundation, Small Animal Clinic, Bünteweg 9, 30559 Hannover, Germany
| | - N Angrisani
- Hannover Medical School, Clinic for Orthopedic Surgery, Anna-von-Borries Str. 1-9, 30625 Hannover, Germany
| | - E Fadeeva
- Laser Zentrum Hannover e.V., Hollerithallee 8, 30419 Hannover, Germany
| | - J Hegermann
- Hannover Medical School, Institute of Functional an Applied Anatomy, Research Core Unit Electron Microscopy, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - J Reifenrath
- Hannover Medical School, Clinic for Orthopedic Surgery, Anna-von-Borries Str. 1-9, 30625 Hannover, Germany.
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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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Hazarika N. Acne vulgaris: new evidence in pathogenesis and future modalities of treatment. J DERMATOL TREAT 2019; 32:277-285. [DOI: 10.1080/09546634.2019.1654075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Neirita Hazarika
- Department of Dermatology, All India Institute of Medical Sciences, Rishikesh, India
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Pathogenesis and management of fracture-related infection. Clin Microbiol Infect 2019; 26:572-578. [PMID: 31446152 DOI: 10.1016/j.cmi.2019.08.006] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Both fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) include orthopaedic implant-associated infections. However, key aspects of management differ due to the bone and soft tissue damage in FRIs and the option of removing the implant after fracture healing. In contrast to PJIs, research and guidelines for diagnosis and treatment in FRIs are scarce. OBJECTIVES This narrative review aims to update clinical microbiologists, infectious disease specialists and surgeons on the management of FRIs. SOURCES A computerized search of PubMed was performed to identify relevant studies. Search terms included 'Fracture' and 'Infection'. The reference lists of all retrieved articles were checked for additional relevant references. In addition, when scientific evidence was lacking, recommendations are based on expert opinion. CONTENT Pathogenesis, prevention, diagnosis and treatment of FRIs are presented. Whenever available, specific data of patients with FRI are discussed. IMPLICATIONS Management of patients with FRI should take into account FRI-specific features. Treatment pathways should implement a multidisciplinary approach to achieve a good outcome. Recently, international consensus guidelines were developed to improve the quality of care for patients suffering from this severe complication, which are highlighted in this review.
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Arain AR, Cole K, Moral M, Thadani S, Rosenbaum A. Bilateral native knee septic arthritis due to Propionibacterium acnes; a case report and review of literature. Clin Case Rep 2019; 7:1605-1607. [PMID: 31428401 PMCID: PMC6692996 DOI: 10.1002/ccr3.2298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/08/2019] [Accepted: 06/16/2019] [Indexed: 12/13/2022] Open
Abstract
Propionibacterium acnes should be considered in any case of indolent septic arthritis. Cultures should be followed for 2 weeks as our cultures were negative for 7 days before growing P. acnes. Irrigation and debridement followed by antibiotics is the standard of care.
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Arain AR, Sullivan CW, Angelicola‐Richardson K, Haddad S, Rosenbaum A. Indolent Propionibacterium acnes infection associated with orthopedic hardware in the ankle: A case report and literature review. Clin Case Rep 2019; 7:1494-1498. [PMID: 31428375 PMCID: PMC6692978 DOI: 10.1002/ccr3.2283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/06/2019] [Indexed: 11/22/2022] Open
Abstract
Propionibacterium acnes (P. acnes) infections of the foot and ankle are very rare and require a unique approach to prevention, diagnosis, and treatment. Clinicians should consider P. acnes as a cause for all late and indolent orthopedic infections, as appropriate surgical and medical management can result in a good outcome.
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Fily F, Jolivet-Gougeon A, Polard E, Gicquel T, Dupont M, Verdier MC, Arvieux C. Moxifloxacin-rifampicin combination for the treatment of non-staphylococcal Gram-positive orthopedic implant-related infections. Med Mal Infect 2019; 49:540-544. [PMID: 31277834 DOI: 10.1016/j.medmal.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/07/2018] [Accepted: 06/19/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We aimed to describe the effectiveness and safety of the moxifloxacin-rifampicin combination in non-staphylococcal Gram-positive orthopedic implant-related infections. METHODS Patients treated with the moxifloxacin-rifampicin combination for an implant-related infection from November 2014 to November 2016 were retrospectively identified from the database of the referral centers for bone and joint infections in Western France. RESULTS Twenty-three cases of infection due to Streptococcus spp. (n=12), Cutibacteriumacnes (n=6), and Enterococcus faecalis (n=5) were included. Ten patients with hip prosthesis were included. Infection was polymicrobial in 11 cases. According to the MIC, moxifloxacin was 1.5 to 11.7 times as active as levofloxacin against non-staphylococcal Gram-positive bacteria. We reported an 81.8% success rate, and no severe adverse effect. CONCLUSION The moxifloxacin-rifampicin combination is a valuable alternative for the treatment of non-staphylococcal Gram-positive implant-related infections because of the good activity of moxifloxacin against these bacteria and the potential activity on the biofilm.
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Affiliation(s)
- F Fily
- Unité des maladies infectieuses, hôpital Broussais, 1, rue de la Marne, 35400 Saint-Malo, France; Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France.
| | - A Jolivet-Gougeon
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Laboratoire de microbiologie, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - E Polard
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Service de pharmacologie clinique et biologique et centre de pharmacovigilance, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - T Gicquel
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - M Dupont
- Unité des maladies infectieuses, hôpital Broussais, 1, rue de la Marne, 35400 Saint-Malo, France
| | - M C Verdier
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Service de pharmacologie clinique et biologique et centre de pharmacovigilance, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - C Arvieux
- Centre de référence pour les infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; Service des maladies infectieuses et réanimation médicale, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
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Tsikopoulos K, Bidossi A, Drago L, Petrenyov DR, Givissis P, Mavridis D, Papaioannidou P. Is Implant Coating With Tyrosol- and Antibiotic-loaded Hydrogel Effective in Reducing Cutibacterium (Propionibacterium) acnes Biofilm Formation? A Preliminary In Vitro Study. Clin Orthop Relat Res 2019; 477:1736-1746. [PMID: 31135555 PMCID: PMC6999983 DOI: 10.1097/corr.0000000000000663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/10/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies have suggested that Cutibacterium acnes (formerly known as Propionibacterium) is the most frequently isolated pathogen after shoulder arthroplasty. To address the burden of periprosthetic joint infections associated with this pathogen, new prevention methods are needed. Tyrosol has a promising record of effectiveness in the field of biofilm-associated infections; however, to our knowledge, it has not been tested against C. acnes thus far. QUESTIONS/PURPOSES In this in vitro study, we asked: (1) Is tyrosol effective in inhibiting and eradicating C. acnes planktonic growth? (2) Is there synergy between tyrosol and rifampicin? (3) Is supplementation of hydrogel with tyrosol at the minimum inhibitory and subinhibitory concentrations efficacious in reducing free-floating C. acnes growth? (4) Is implant hydrogel coating (either alone or combined with tyrosol, rifampicin, or vancomycin) beneficial in reducing C. acnes biofilm formation? (5) Is the administration of soluble tyrosol an effective measure against C. acnes biofilm formation? METHODS We assessed C. acnes planktonic growth and eradication by inspecting visually the results of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assays. We also evaluated macroscopically the presence of synergy among tyrosol and rifampicin by means of the MIC checkerboard testing. Thereafter, we addressed colorimetrically the efficacy of tyrosol-loaded Defensive Antibacterial Coating (DAC®) hydrogel against the C. acnes free-floating form by means of the XTT cell proliferation reduction assay. Then, we explored photometrically the effect of hydrogel and soluble tyrosol at reducing C. acnes biofilm formation on titanium alloy disks that simulated orthopaedic implants by using the minimum biofilm inhibition concentration assay. In particular, 16 disks were sequentially allocated to each of the following testing conditions: (1) hydrogel alone; (2) tyrosol-loaded hydrogel; (3) rifampicin-supplemented hydrogel; (4) vancomycin-loaded hydrogel; and (5) soluble tyrosol. Subsequently, implants were sonicated and cell viability was evaluated in terms of the XTT assay. RESULTS Tyrosol was effective in inhibiting C. acnes planktonic (free-floating) growth demonstrating MIC values of 63 mM (9 mg/mL) and MBC values of 250 mM (35 mg/mL). Concerning synergy assessment, the checkerboard testing revealed additivity among tyrosol and rifampicin with a fractional inhibitory concentration index of 0.56. In addition, a hydrogel coating with tyrosol at the MIC showed no difference in the inhibition of free-floating C. Acnes form over control (median absorbance [MA] for tyrosol-supplemented hydrogel versus control groups were 0.21 [interquartile range {IQR}, 0.19-0.24] versus 0.26 [IQR, 0.23-0.31], p = 0.066). Furthermore, loaded hydrogel with tyrosol at 597 mg/mL (1 M) was no more effective than control in reducing C. acnes biofilm formation (MAs for tyrosol versus control were 0.12 [IQR, 0.11-0.13] versus 0.14 [IQR, 0.12-0.16], respectively; p = 0.076). This was also the case when we considered hydrogel in conjunction with vancomycin and rifampicin (MAs for vancomycin at 2% and 5% and rifampicin at 1% versus biofilm control were 0.139 [IQR, 0.133-0.143] and 0.141 [IQR, 0.133-0.143] and 0.135 [IQR, 0.128-0.146] versus 0.142 [IQR, 0.136-0.144], correspondingly). In contrast, soluble tyrosol at 597 mg/mL (1 M) inhibited biofilm formation compared to control (MAs for tyrosol and control groups were 0.11 [IQR, 0.09-0.13] versus 0.13 [IQR, 0.12-0.14], p = 0.007). CONCLUSIONS Although the implant coating with hydrogel (either pure or supplemented with antimicrobial agents) did not diminish C. acnes biofilm development in vitro, soluble tyrosol at 597 mg/mL (1 M) exceeded the meaningful biofilm inhibition threshold of 80%. CLINICAL RELEVANCE The results of the current preclinical investigation did not support the use of a fast, bioresorbable hydrogel as a coating method against C. acnes biofilms. Instead, direct local administration of soluble tyrosol at high concentrations should be further tested in future animal studies.
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Affiliation(s)
- Konstantinos Tsikopoulos
- K. Tsikopoulos, P. Papaioannidou, 1st Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece K. Tsikopoulos, 424 Army General Training Hospital, Thessaloniki, Greece; and 2nd Orthopaedic Department, Papageorgiou General Hospital, Thessaloniki, Greece A. Bidossi, IRCCS Orthopedic Institute Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy L. Drago, Laboratory of Clinical Microbiology, Department of Biochemical Sciences for Health, University of Milan, Milan, Italy D. R. Petrenyov, Gomel State Medical University, Scientific Research Laboratory, Gomel, Belarus; and Institute of Radiobiology of National Academy of Sciences, Laboratory of Endocrinology and Biochemistry, Gomel, Belarus P. Givissis, 1st Orthopaedic Department of Aristotle University, G. Papanikolaou General, Hospital, Exohi, Thessaloniki, Greece D. Mavridis, Department of Primary Education, University of Ioannina, University Campus, Ioannina, Greece
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[Febrile myalgia revealing Propionibacterium acnes endocarditis]. Rev Med Interne 2019; 40:613-616. [PMID: 31229357 DOI: 10.1016/j.revmed.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Propionibacterium acnes endocarditis is rare and difficult to diagnose. We report a case of Propioniacterium acnes endocarditis revealed by a lower limb fasciitis. CASE REPORT A 54-year-old patient presented with recurrent febrile myalgia of the lower limbs, that appeared three years after an aortic surgery (aortic valve sparing reimplentation and ascending aortic prosthesis implantation). Computer tomography showed fasciitis of both legs. Positron emission tomography showed 18Fluorodeoxyglucose intake of the aortic prosthesis and in muscles of the lower limbs. Ten days after blood sample drawing, cultures showed the presence of Propionibacterium acnes. The aortic prosthesis was surgically removed, whose culture confirmed infection by Propionibacterium acnes. The diagnosis of infective endocarditis revealed by lower limb emboli was made. Evolution was favorable. CONCLUSION In patients with vascular prostheses, Propionibacterium acnes infection must be evoked face to an atypical inflammatory process. Very prolonged blood culture incubation is needed to identify the pathogen.
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Garrigues GE, Zmistowski B, Cooper AM, Green A. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: management of periprosthetic shoulder infection. J Shoulder Elbow Surg 2019; 28:S67-S99. [PMID: 31196516 DOI: 10.1016/j.jse.2019.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/20/2019] [Indexed: 02/05/2023]
Abstract
The Second International Consensus Meeting on Orthopedic Infections was held in Philadelphia, Pennsylvania, in July 2018. A multidisciplinary team of international experts from all 9 subspecialties of orthopedic surgery and allied fields of infectious disease, microbiology, and epidemiology was assembled to form the International Consensus Group. The following consensus proceedings from the International Consensus Meeting involve 30 questions pertaining to the management of periprosthetic shoulder infection.
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Affiliation(s)
- Grant E Garrigues
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
| | - Benjamin Zmistowski
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexus M Cooper
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Hemolysis Is a Diagnostic Adjuvant for Propionibacterium acnes Orthopaedic Shoulder Infections. J Am Acad Orthop Surg 2019; 27:136-144. [PMID: 30247311 DOI: 10.5435/jaaos-d-17-00394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to further evaluate the pathogenicity of hemolytic and nonhemolytic phenotypes of Propionibacterium acnes (P acnes) isolates from shoulders of orthopaedic patients. METHODS Thirty-one patient records were reviewed, which had a positive P acnes shoulder culture from joint aspiration fluid and/or intraoperative tissues for demographics, clinical course, culture, and laboratory data. Patients were categorized as definite infection, probable infection, or probable contaminant. Antibiotic resistance patterns and hemolysis characteristics were subsequently analyzed. RESULTS Hemolysis demonstrated 100% specificity with a positive predictive value of 100% and 80% sensitivity with a negative predictive value of 73% for determining definite and probable infections. Hundred percent of the patients in the hemolytic group and only 27% of patients in the nonhemolytic group were classified as infected. Presenting inflammatory markers were markedly higher in the hemolytic group. Clindamycin resistance was found in 31% of the hemolytic strains, whereas no antibiotic resistance was observed in the nonhemolytic group. CONCLUSION Hemolytic strains of P acnes exhibit enhanced pathogenicity to their host by eliciting a more prominent systemic inflammatory response, increased antibiotic resistance, and a more challenging clinical course. Hemolysis may serve as a specific marker for assisting in diagnosing true infection with P acnes. LEVEL OF EVIDENCE Level III retrospective comparative study.
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Boyle KK, Kuo FC, Horcajada JP, Hughes H, Cavagnaro L, Marculescu C, McLaren A, Nodzo SR, Riccio G, Sendi P, Silibovsky R, Stammers J, Tan TL, Wimmer M. General Assembly, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S225-S237. [PMID: 30360976 DOI: 10.1016/j.arth.2018.09.074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Role of Rifampin against Staphylococcal Biofilm Infections In Vitro, in Animal Models, and in Orthopedic-Device-Related Infections. Antimicrob Agents Chemother 2019; 63:AAC.01746-18. [PMID: 30455229 DOI: 10.1128/aac.01746-18] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rifampin has been used as an agent in combination therapy in orthopedic device-related infections (ODRI) for almost three decades. The aim of this review is to provide data regarding the role of rifampin against biofilm infection in vitro, in animal models, and in clinical ODRI. Available data are gathered in order to present the rational use of rifampin combinations in patients with periprosthetic joint infection (PJI). The role of rifampin is well defined in patients with PJI and is indicated in those who fulfill the Infectious Diseases Society of America criteria for debridement and implant retention or one-stage exchange. It should be used with care because of the danger of rapid emergence of resistance. Potential drug interactions should be considered.
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