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

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Abstract

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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Acknowledgements

The authors owe their gratitude to Mrs Chris Dyche, who kindly assisted with the retrieval of medical records. MT is funded by a UK National Institute for Health Research (NIHR) Clinical Lectureship, and is receiving additional funding from the UK Technology Strategy Board (TSB), as well as support from the Southampton NIHR Respiratory Biomedical Research Unit. SNF is part-funded by the Southampton NIHR Wellcome Trust Clinical Research Facility. No funding specifically related to this study was received.

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All authors—none related to this manuscript.

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Authors and Affiliations

  1. Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK

    M. Tebruegge, C. Jones, H. de Graaf, P. Sukhtankar & S. N. Faust

  2. Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    M. Tebruegge, S. Patel & S. N. Faust

  3. Institute for Life Sciences, University of Southampton, Southampton, UK

    M. Tebruegge, R. P. Howlin & S. N. Faust

  4. Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    M. Tebruegge, R. P. Howlin & S. N. Faust

  5. Department of Paediatrics, The University of Melbourne, Parkville, Australia

    M. Tebruegge

  6. Southampton National Institute for Health Research Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    H. de Graaf, P. Sukhtankar, R. N. Allan, S. Patel & S. N. Faust

  7. Centre for Biological Sciences, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, UK

    R. P. Howlin

  8. Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    D. Browning, H. Schuster & A. Pallett

  9. Public Health England South East Regional Laboratory, Southampton, UK

    D. Browning & H. Schuster

  10. NIHR Wellcome Trust Clinical Research Facility, Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK

    M. Tebruegge

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  1. M. Tebruegge
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  2. C. Jones
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  3. H. de Graaf
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Correspondence to M. Tebruegge.

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Tebruegge, M., Jones, C., de Graaf, H. et al. Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome. Eur J Clin Microbiol Infect Dis 34, 527–534 (2015). https://doi.org/10.1007/s10096-014-2256-y

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  • DOI: https://doi.org/10.1007/s10096-014-2256-y

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