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[Postoperative subdural empyema due to Propionibacterium acnes]
Youichi Uozumi1, Hiroshi Nawashiro, Reiko Higo
1Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa-city, Saitama 359-8513, Japan.
Abstract:
Propionibacterium acnes are gram-positive pleomorphic rods that grow under an anaerobic condition. They are the most frequent inhabitants of sebaceous glands of skin, hair follicles, mouth, upper respiratory tract, and as a frequent contaminant in laboratory cultures. Propionibacterium acnes is an underestimated but significant cause of postneurosurgical infection, especially in the presence of foreign bodies such as shunt systems. We present a rare case with a postoperative subdural empyema in which the only pathogen isolated was Propionibacterium acnes. In our case, the clinical course was atypically rapid. The most effective antibiotic therapy for Propionibacterium acnes infections has not been established. However, high dose penicillin in combination with surgical drainage and removal of foreign bodies is recommended as the treatment of choice.
Insights
Propionibacterium acnes, a common skin bacterium, can cause serious post-neurosurgical infections, particularly with implants. This case highlights its rapid progression and suggests penicillin plus surgery as a treatment approach.
Area of Science:
- Microbiology
- Infectious Diseases
- Neurosurgery
Background:
- Propionibacterium acnes (P. acnes) are anaerobic, gram-positive bacteria commonly found on skin and mucous membranes.
- P. acnes is an underappreciated cause of infections, especially in neurosurgical patients with foreign bodies like shunts.
- Subdural empyema is a serious complication following neurosurgical procedures.
Observation:
- A rare case of postoperative subdural empyema is presented.
- The only pathogen isolated from the empyema was Propionibacterium acnes.
- The patient experienced an unusually rapid clinical deterioration.
Findings:
- Propionibacterium acnes can cause aggressive subdural empyema.
- The rapid clinical course observed in this case underscores the potential severity of P. acnes infections.
- Optimal antibiotic therapy for P. acnes infections remains to be definitively established.
Implications:
- This case emphasizes the importance of considering P. acnes in the differential diagnosis of post-neurosurgical infections.
- Prompt surgical intervention, including foreign body removal, is crucial.
- High-dose penicillin, in conjunction with surgical management, is recommended as the primary treatment strategy for P. acnes-related subdural empyema.