ABSTRACT
Propionibacterium acnes colonizes the lipid-rich sebaceous glands of the skin. This preferential anaerobic bacterium is easily identified if cultures are prolonged. It is involved in the inflammation process of acne, but until recently, it was neglected in other clinical presentations. Despite a reported low virulence, the new genomic, transcriptomic, and phylogenetic studies have allowed better understanding of this pathogen's importance that causes many chronic and recurrent infections, including orthopedic and cardiac prosthetic, and breast or eye implant-infections. These infections, facilitated by the ability of P. acnes to produce a biofilm, require using anti-biofilm active antibiotics such as rifampicin. The antibiogram of P. acnes is not systematically performed in microbiology laboratories because of its susceptibility to a wide range of antibiotics. However, in the last 10 years, the rate of antibiotic-resistant bacteria has increased, especially for macrolides and tetracyclines. Recently, rpoB gene mutations conferring resistance to rifampicin have been also reported. Thus in case of a biofilm growth mode, the therapeutic strategy should be discussed, according to the resistance phylotype and phenotype so as to optimize the treatment of these severe infections.
Subject(s)
Communicable Diseases, Emerging , Gram-Positive Bacterial Infections/microbiology , Propionibacterium acnes/pathogenicity , Acne Vulgaris/microbiology , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/physiology , Bacterial Typing Techniques , Biofilms , Breast Implants/adverse effects , Breast Implants/microbiology , Cerebrospinal Fluid Shunts/adverse effects , DNA, Bacterial/genetics , Drug Resistance, Multiple, Bacterial/genetics , Endophthalmitis/etiology , Endophthalmitis/microbiology , Eye Infections, Bacterial/etiology , Eye Infections, Bacterial/microbiology , Genome, Bacterial , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/transmission , Host-Pathogen Interactions , Humans , Lenses, Intraocular/adverse effects , Lenses, Intraocular/microbiology , Microbial Sensitivity Tests/methods , Phylogeny , Propionibacterium acnes/classification , Propionibacterium acnes/drug effects , Propionibacterium acnes/genetics , Propionibacterium acnes/isolation & purification , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/microbiology , Virulence/geneticsABSTRACT
The purpose of this study was to compare the diagnostic accuracy for the detection of infection between the culture of fluid obtained by sonication (SFC) and the culture of peri-implant tissues (PITC) in patients with early and delayed implant failure, and those with unsuspected and suspected septic failure. It was hypothesised that SFC increases the diagnostic accuracy for infection in delayed, but not early, implant failure, and in unsuspected septic failure. The diagnostic accuracy for infection of all consecutive implants (hardware or prostheses) that were removed for failure was compared between SFC and PITC. This prospective study included 317 patients with a mean age of 62.7 years (9 to 97). The sensitivity for detection of infection using SFC was higher than using PITC in an overall comparison (89.9% versus 67%, respectively; p < 0.001), in unsuspected septic failure (100% versus 48.5%, respectively; p < 0.001), and in delayed implant failure (88% versus 58%, respectively; p < 0.001). PITC sensitivity dropped significantly in unsuspected compared with suspected septic failure (p = 0.007), and in delayed compared with early failure (p = 0.013). There were no differences in specificity. Sonication is mainly recommended when there is implant failure with no clear signs of infection and in patients with delayed implant failure. In early failure, SFC is not superior to PITC for the diagnosis of infection and, therefore, is not recommended as a routine diagnostic test in these patients.
