Delayed postoperative intracerebral abscess caused by<i>Proprionibacterium acnes</i>: case report and review of the literature

Barazi, Sinan; Gnanalingham, Kanna; Chopra, I.; Dellen, James R. van

doi:10.1080/02688690310001601225

Cited by 34 publications

(31 citation statements)

References 6 publications

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“…This suggests that thorough surgical evacuation of infected material may be more important to the outcome than the post-operative antibiotic regimen. Based on our experience and the literature review, it is Author Findings Management Barazi et al 9 1 case of brain abscess 18 months after craniotomy for tumor excision…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][8][9][10][11][12] To our knowledge, it is the largest published series on this topic. Our study summarizes the early management plans and outlines our recommendations based on these findings.…”

Section: Discussionmentioning

confidence: 99%

“…The mean time to symptom onset in five patients was 8.4 (range [4][5][6][7][8][9][10][11][12][13][14] weeks postoperatively. Patient 6 who had been treated for optic nerve meningiomas was unique in that symptoms did not develop until 192 weeks after surgery.…”

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confidence: 99%

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Propionibacterium Acnes Infections After Cranial Neurosurgery

Kelly

Fourney

Guzman

et al. 2006

Can. j. neurol. sci.

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THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCESPropionibacterium acnes (P. acnes) is an anaerobic grampositive bacillus found as a normal component of the bacterial flora of the skin, hair follicles and sebaceous glands. Although the majority of patient isolates are thought to be contaminants, Propionibacterium acnes does cause significant disease in a small subset of patients after neurosurgical procedures. 1Ventriculoperitoneal shunt infections are the most commonly reported type of P. acnes infection in the neurosurgical literature.2,3 However, several reports describe P. acnes infections after craniotomy [4][5][6][7][8] and it has been suggested that central nervous system infections caused by P. acnes are more important than previously recognized. We report on our single ABSTRACT: Background: Propionibacterium acnes (P. acnes) is a relatively avirulent organism that is part of the normal skin flora. Most patient isolates are considered contaminants but, in a small subset of patients, particularly in the post-neurosurgery setting, the organism can cause significant infections. We reviewed our experience with the occurrence and management of P. acnes infections after cranial neurosurgical procedures over a five-year period. Methods: Patients with positive cultures for P. acnes between 1996 and 2001 were identified by review of the Saskatoon Health Region microbiology laboratory database. Of the 141 positive cultures, a review of hospital records identified six patients with P. acnes infections after neurosurgical procedures. A review of the literature related to P. acnes associated CNS infections was conducted. Results: All patients had undergone a craniotomy or burrhole placement, and one patient had received prior radiotherapy. There were no P. acnes-related ventriculoperitoneal shunt infections. All patients presented with scalp swelling and three had purulent discharge. Symptoms occurred more than two months after the initial surgery in five of six patients, while one patient developed symptoms three years post-operatively. Management for all patients included removal of the craniotomy flap and treatment with parenteral antibiotics, followed in most cases by oral antibiotics. A good response without relapse of infection was seen in five patients; one patient had recurrent infection after cranioplasty. Conclusions: P. acnes is a rare but important cause of infection after craniotomy. Wound debridement, removal of the bone flap and adequate antibiotic coverage result in cure in the majority of patients.RÉSUMÉ: Infection à Corynebacterium acnes après une neurochirurgie crânienne. Contexte : Le Corynebacterium acnes est un organisme relativement avirulent qui fait partie de la flore cutanée normale. On considère que la plupart des isolats de patients sont des contaminants. Cependant chez un petit sous-groupe de patients, particulièrement après une neurochirurgie, ce microorganisme peut causer des infections importantes. Nous revoyons notre expérience sur une période de 5 ans de l'infection à C. acnes et de son ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Propionibacterium Acnes Infections After Cranial Neurosurgery

Kelly

Fourney

Guzman

et al. 2006

Can. j. neurol. sci.

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“…P. acnes is being recognized as a causal agent in shoulder infections with increasing frequency [3,7,14,18,33,35,37,39,45]. This nonspore-forming microaerophilic bacillus has a low level of virulence but has been established as a pathogen in endocarditis [30,42], meningitis [5,43], arthritis [23], osteomyelitis [1,31] and spondylitis [10,13]. It has been described as the infectious etiology in 16% of prosthetic shoulder infections [38] and in 21% of revision shoulder arthroplasties [22].…”

Section: Introductionmentioning

confidence: 99%

Propionobacter acnes Infection as an Occult Cause of Postoperative Shoulder Pain: A Case Series

Millett

Yen

Price

et al. 2011

Clinical Orthopaedics &Amp; Related Research

112

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“…acnes is now a recognized pathogen in neurosurgery (23,28), often giving rise to infections with delayed presentation (3,12). Shunt infections due to P. acnes bacteria, also often with delayed presentation, have been reported (1, 4, 30, 31).…”

Section: Discussionmentioning

confidence: 99%

Activity of an Antimicrobial Hydrocephalus Shunt Catheter against Propionibacterium acnes

Bayston

Vera

Ashraf

2010

Antimicrob Agents Chemother

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Shunt infection is a major complication affecting approximately 10% of procedures. Propionibacterium acnes, an anaerobic skin bacterium, is increasingly recognized as a shunt pathogen, causing up to 14% of infections. Though susceptible to penicillin and cephalosporins, P. acnes shunt infections are not preventable by means of perioperative prophylaxis, due to poor cerebrospinal fluid penetration. Antimicrobial shunts with activity against staphylococci are available, but their activity against P. acnes is unknown, and the study was designed to determine this. Three methods of evaluation were used in order to determine the emergence of resistance when exposure is to high inocula for long periods, the time taken to kill 100% of the bacteria attached to the shunt, and the duration of activity under constant flow conditions with repeated bacterial challenge. Despite repeated exposure to high bacterial inocula over 70 days, no resistance was seen. The time taken to kill all attached bacteria, 96 h, was twice that taken to kill attached staphylococci. Nevertheless, under constant flow conditions with repeated challenges, the antimicrobial catheters resisted colonization by P. acnes for 56 days. Using tests that were designed to be clinically predictive when done together, the results suggest that the antimicrobial catheters will be able to prevent colonization of hydrocephalus shunts by P. acnes.Hydrocephalus is the pathological accumulation of cerebrospinal fluid (CSF) in the cerebral ventricles and is caused by a variety of factors, such as intrauterine infection, meningitis, hemorrhage, and tumors. The standard treatment is surgical insertion of a shunt, a silicone tubular device that drains CSF from the cerebral ventricles to another body site, usually the peritoneal cavity. Infection is a serious complication of shunting, the incidence ranging from less than 1% to over 15%, with an overall incidence of about 10% (13,18). Shunt infection in the United States has been estimated to account for more than $100 million in national health care expenditure annually (29). The causative bacteria are usually of skin origin, and coagulase-negative staphylococci (CoNS) predominate. However, a proportion of shunt infections, reported to be approximately 14%, is caused by Propionibacterium acnes, also a normal skin inhabitant (1,4,30). This organism is anaerobic and slow growing and often fails to be detected. Like CoNS, P. acnes adheres to the inner surfaces of the shunt catheters and develops a biofilm (4, 11), leading to antibiotic treatment failure and necessitating shunt removal.Although antimicrobial prophylaxis is almost universally used, its role in reducing the incidence of shunt infections remains controversial. Systemic antibiotics penetrate the blood-cerebrospinal fluid barrier poorly in the absence of inflammation (2,17,20,21,22). The use of intraventricular antibiotics to overcome this has not been successful (6, 32), with the possible exception of the combination of intraventricular gentamicin and vancomycin, wh...

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Delayed postoperative intracerebral abscess caused byProprionibacterium acnes: case report and review of the literature

Cited by 34 publications

References 6 publications

Propionibacterium Acnes Infections After Cranial Neurosurgery

Propionibacterium Acnes Infections After Cranial Neurosurgery

Propionobacter acnes Infection as an Occult Cause of Postoperative Shoulder Pain: A Case Series

Activity of an Antimicrobial Hydrocephalus Shunt Catheter against Propionibacterium acnes

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