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Propionibacterium acnes: an agent of prosthetic joint infection and colonization

Valérie Zeller1, Ali Ghorbani, Christophe Strady

  • 1Service d'Orthopédie et de Traumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France. vzeller@hopital-dcss.org

The Journal of Infection
|April 10, 2007
PubMed
Abstract

Insights

Propionibacterium acnes prosthetic joint infections (PJI) can manifest as early or late-onset disease. Early PJI suggests infection, while late PJI indicates colonization, both treatable with surgery and antibiotics.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Microbiology

Background:

  • Prosthetic joint infection (PJI) poses diagnostic challenges, particularly with slow-growing bacteria like Propionibacterium acnes.
  • Understanding P. acnes PJI is crucial for effective patient management.

Purpose of the Study:

  • To characterize the epidemiology, clinical presentation, and biological features of P. acnes PJI.
  • To evaluate treatment outcomes and compare PJI presentations based on symptom onset timing.
  • To differentiate between infection and colonization in P. acnes PJI.

Main Methods:

  • A cohort study involving 50 patients diagnosed with P. acnes PJI.
  • Diagnosis confirmed by multiple positive intraoperative cultures during revision arthroplasty.
  • Patients categorized by symptom onset: within 2 years or after 2 years post-index operation.

Main Results:

  • The study included 50 patients with PJI in hip, knee, or shoulder prostheses.
  • Patients with symptom onset within 2 years had more prior prostheses and infection signs, suggesting true infection.
  • Late symptom onset (>2 years) was associated with prosthesis colonization.
  • Successful treatment (92%) involved exchange arthroplasty and prolonged antibiotics.

Conclusions:

  • Propionibacterium acnes can cause diverse PJI presentations, including late chronic infections and colonization.
  • Distinguishing early infection from late colonization is key for appropriate PJI management.
  • Combined surgical intervention and antibiotic therapy are highly effective for P. acnes PJI.

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