Septic Nonunions of Lower Limb Long Bones

Gaillard, C.; Dupond, M.; Brisou, P.; Gaillard, Tiphaine

doi:10.1177/1534734613489990

Cited by 2 publications

(2 citation statements)

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“…It would therefore be premature on the basis of our current data to claim that there is a direct link between low-grade disc infections with P. acnes and CLBP or failed lumbar arthrodesis surgery, even though there is an increasing body of literature pointing into that direction [28–30]. …”

Section: Discussionmentioning

confidence: 99%

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

et al. 2017

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BackgroundIn previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of ~25% of patients undergoing microdiscectomy, suggesting a possible link between chronic bacterial infection and disc degeneration. However, given the prominence of P. acnes as a skin commensal, such analyses often struggled to exclude the alternate possibility that these organisms represent perioperative microbiologic contamination. This investigation seeks to validate P. acnes prevalence in resected disc cultures, while providing microscopic evidence of P. acnes biofilm in the intervertebral discs.MethodsSpecimens from 368 patients undergoing microdiscectomy for disc herniation were divided into several fragments, one being homogenized, subjected to quantitative anaerobic culture, and assessed for bacterial growth, and a second fragment frozen for additional analyses. Colonies were identified by MALDI-TOF mass spectrometry and P. acnes phylotyping was conducted by multiplex PCR. For a sub-set of specimens, bacteria localization within the disc was assessed by microscopy using confocal laser scanning and FISH.ResultsBacteria were cultured from 162 discs (44%), including 119 cases (32.3%) with P. acnes. In 89 cases, P. acnes was cultured exclusively; in 30 cases, it was isolated in combination with other bacteria (primarily coagulase-negative Staphylococcus spp.) Among positive specimens, the median P. acnes bacterial burden was 350 CFU/g (12 - ~20,000 CFU/g). Thirty-eight P. acnes isolates were subjected to molecular sub-typing, identifying 4 of 6 defined phylogroups: IA1, IB, IC, and II. Eight culture-positive specimens were evaluated by fluorescence microscopy and revealed P. acnes in situ. Notably, these bacteria demonstrated a biofilm distribution within the disc matrix. P. acnes bacteria were more prevalent in males than females (39% vs. 23%, p = 0.0013).ConclusionsThis study confirms that P. acnes is prevalent in herniated disc tissue. Moreover, it provides the first visual evidence of P. acnes biofilms within such specimens, consistent with infection rather than microbiologic contamination.

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Section: Discussionmentioning

confidence: 99%

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

et al. 2017

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“…There is, however, a growing recognition that bacteria are an underestimated cause of subacute and chronic bone infections, aseptic loosening of implants, and arthrodesis after osteosynthesis (7)(8)(9)(10)(11). In particular, P. acnes is being increasingly recognized as a primary pathogen in relation to prosthetic shoulder implant infection (12), but it has also been linked to other medical device-related infections, including those associated with prosthetic hip joints and heart valves, as well as central nervous system shunts (13)(14)(15).…”

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confidence: 99%

Propionibacterium acnes and Staphylococcus lugdunensis Cause Pyogenic Osteomyelitis in an Intramedullary Nail Model in Rabbits

et al. 2014

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b Propionibacterium acnes and coagulase-negative staphylococci (CoNS) are opportunistic pathogens implicated in prosthetic joint and fracture fixation device-related infections. The purpose of this study was to determine whether P. acnes and the CoNS species Staphylococcus lugdunensis, isolated from an "aseptically failed" prosthetic hip joint and a united intramedullary nail-fixed tibial fracture, respectively, could cause osteomyelitis in an established implant-related osteomyelitis model in rabbits in the absence of wear debris from the implant material. The histological features of P. acnes infection in the in vivo rabbit model were consistent with localized pyogenic osteomyelitis, and a biofilm was present on all explanted intramedullary (IM) nails. The animals displayed no outward signs of infection, such as swelling, lameness, weight loss, or elevated white blood cell count. In contrast, infection with S. lugdunensis resulted in histological features consistent with both pyogenic osteomyelitis and septic arthritis, and all S. lugdunensis-infected animals displayed weight loss and an elevated white blood cell count despite biofilm detection in only two out of six rabbits. The differences in the histological and bacteriological profiles of the two species in this rabbit model of infection are reflective of their different clinical presentations: low-grade infection in the case of P. acnes and acute infection for S. lugdunensis. These results are especially important in light of the growing recognition of chronic P. acnes biofilm infections in prosthetic joint failure and nonunion of fracture fixations, which may be currently reported as "aseptic" failure.

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Septic Nonunions of Lower Limb Long Bones

Cited by 2 publications

References 10 publications

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

Propionibacterium acnes and Staphylococcus lugdunensis Cause Pyogenic Osteomyelitis in an Intramedullary Nail Model in Rabbits

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