Propionibacterium Acnes Infections After Cranial Neurosurgery

Kelly, Michael; Fourney, Daryl R.; Guzman, Raphael; Sadanand, Venkatraman; Griebel, Robert; Sanche, Stephen

doi:10.1017/s0317167100005151

Cited by 27 publications

(18 citation statements)

References 19 publications

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“…In only 2 patients (4.1 %) out of the entire study population no predisposing factors were identified (the patients with infection of the talocrural joint and thoracic empyema), suggesting that these infections might have occurred spontaneously. This observation is in keeping with the marked predominance of reports describing invasive P. acnes infections following neurosurgical and orthopaedic operations in the literature, and the paucity of publications reporting cases with no apparent risk factors [11][12][13][14][15][16][17][18][19][20][21][22][25][26][27].…”

Section: Discussionsupporting

confidence: 79%

Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome

Tebruegge

Jones

Sukhtankar

et al. 2014

Eur J Clin Microbiol Infect Dis

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An increasing number of reports suggest that Propionibacterium acnes can cause serious invasive infections. Currently, only limited data exist regarding the spectrum of invasive P. acnes infections. We conducted a non-selective cohort study at a tertiary hospital in the UK over a 9-year-period (2003-2012) investigating clinical manifestations, risk factors, management, and outcome of invasive P. acnes infections. Forty-nine cases were identified; the majority were neurosurgical infections and orthopaedic infections (n = 28 and n = 15 respectively). Only 2 cases had no predisposing factors; all neurosurgical and 93.3 % of orthopaedic cases had a history of previous surgery and/or trauma. Foreign material was in situ at the infection site in 59.3 % and 80.0 % of neurosurgical and orthopaedic cases respectively. All neurosurgical and orthopaedic cases required one or more surgical interventions to treat P. acnes infection, with or without concomitant antibiotic therapy; the duration of antibiotic therapy was significantly longer in the group of orthopaedic cases (median 53 vs 19 days; p = 0.0025). All tested P. acnes isolates were susceptible to penicillin, ampicillin and chloramphenicol; only 1 was clindamycin-resistant. Neurosurgical and orthopaedic infections account for the majority of invasive P. acnes infections. Most cases have predisposing factors, including previous surgery and/or trauma; spontaneous infections are rare. Foreign material is commonly present at the site of infection, indicating that the pathogenesis of invasive P. acnes infections likely involves biofilm formation. Since invasive P. acnes infections are associated with considerable morbidity, further studies are needed to establish effective prevention and optimal treatment strategies.

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Section: Discussionsupporting

confidence: 79%

Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome

Tebruegge

Jones

Sukhtankar

et al. 2014

Eur J Clin Microbiol Infect Dis

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“…The most common germ in our series was P. acnes. This anaerobic Gram-positive bacillus, found as a normal component of the bacterial flora of the skin, is a common causative germ for infection after craniotomy [25]. The most common infecting organism is reported to be Staphylococcus aureus [10], which was the second most common bacterium in our series.…”

Section: Discussionmentioning

confidence: 61%

Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty

et al. 2012

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Cranioplasty is a common neurosurgical procedure. Free-hand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes is often time-consuming and may result in disappointing cosmetic outcomes. Computer-assisted patient-specific implants address these disadvantages but are associated with long production times and high costs. In this study, we evaluated the clinical, radiological, and cosmetic outcomes of a timesaving and inexpensive intraoperative method to mold custom-made implants for immediate single-stage or delayed cranioplasty. Data were collected from patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma. A PMMA replica was cast between a negative form of the patient's own bone flap and the original bone flap with exactly the same shape, thickness, and dimensions. Clinical and radiological follow-up was performed 2 months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analogue scale for cosmesis) were evaluated 1 to 3 years after cranioplasty. Twenty-seven patients underwent intraoperative template-molded patient-specific cranioplasty with PMMA. The indications for cranioplasty included bone flap infection (56%, n015), calvarian tumor resection (37%, n010), and defect after trauma (7%, n02). The mean duration of the molding procedure was 19±7 min. Excellent radiological implant alignment was achieved in 94% of the cases. All (n023) but one patient rated the cosmetic outcome (mean 1.4 years after cranioplasty) as excellent (70%, n016) or good (26%, n06). Intraoperative cast-molded reconstructive cranioplasty is a feasible, accurate, fast, and cost-efficient technique that results in excellent cosmetic outcomes, even with large and complex skull defects.Keywords Patient-specific implant . Cranioplasty . Skull bone flap . Bone replacement material polymethyl methacrylate-PMMA . Brain tumors . Trauma . Brain

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“…13 The indolent nature of infection with this pathogen is illustrated by the prolonged duration of symptoms prior to presentation, rarity of fever, usually normal white blood count, no attributable mortality and the significant time lapse from previous neurosurgery to presentation. These findings are similar to previous reports.…”

Section: Discussionmentioning

confidence: 99%

Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection

Nisbet

Briggs

et al. 2007

Journal of Antimicrobial Chemotherapy

106

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Background: Propionibacterium acnes is increasingly recognized as a cause of post-neurosurgical infection. This review of patients with P. acnes neurosurgical infection was carried out in order to determine clinical characteristics and outcomes in relation to duration of antimicrobial treatment. Methods:We retrospectively reviewed the charts of consecutive patients with P. acnes isolated from neurosurgical specimens from 1 January 1999 to 30 June 2005. We defined P. acnes neurosurgical infection as isolation of P. acnes alone from a sterile neurosurgical site in a patient who clinically improved following treatment with an appropriate antibiotic. Results:We identified 28 patients with definite P. acnes neurosurgical infection; median age 49 years (range 23-77); 15 (54%) male. All patients had prior neurosurgical procedures: 27 (96%) post-craniotomy. The median time from surgery to presentation was 54 days (range 12-1578). Eighteen out of 28 (64%) patients who met the definition of neurosurgical infection had Gram-positive bacilli seen in at least one surgical specimen compared with only 2/56 (4%) patients who did not meet the definition (P < 0.0001). Intravenous benzyl penicillin + + + + + oral penicillin VK was the most common treatment. The median duration of antibiotic treatment for intracranial infection was 29 days. Five of nine patients who had extracranial bone-flap-associated infection had 7 days of intravenous treatment and were cured. Two patients had relapse or reinfection.Conclusions: P. acnes neurosurgical infection often presents in an indolent fashion. Gram-positive bacilli on Gram stain should not be discounted as a contaminant in neurosurgical specimens. Associated bone flaps should be removed. Intravenous benzyl penicillin + + + + + oral penicillin VK remains effective treatment.

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Propionibacterium Acnes Infections After Cranial Neurosurgery

Cited by 27 publications

References 19 publications

Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome

Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome

Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty

Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection

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