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Propionibacterium acnes vertebral osteomyelitis: seek and ye shall find?

Todd J Kowalski1, Elie F Berbari, Paul M Huddleston

  • 1Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.

Clinical Orthopaedics and Related Research
|May 8, 2007
PubMed

Insights

Propionibacterium acnes can cause vertebral osteomyelitis, often with atypical clinical, radiographic, and histopathology findings. Early recognition and appropriate antimicrobial therapy are crucial for favorable outcomes in these non-implant-associated infections.

Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Microbiology

Background:

  • Propionibacterium acnes (P. acnes) is a known pathogen in implant-associated spine infections.
  • Clinical manifestations and outcomes of P. acnes in non-implant-associated vertebral osteomyelitis are not well-defined.

Purpose of the Study:

  • To investigate the clinical findings, laboratory results, radiographic features, and histopathology of non-implant-associated P. acnes vertebral osteomyelitis.
  • To determine the clinical outcomes related to medical and surgical treatments for this condition.

Main Methods:

  • Retrospective review of nine male patients diagnosed with P. acnes vertebral osteomyelitis.
  • Analysis of laboratory results, imaging examinations, and histopathology findings.
  • Evaluation of treatment strategies and patient outcomes.

Main Results:

  • Atypical findings were common: two patients had no suggestive imaging, five of six had normal erythrocyte sedimentation rates, and three of six lacked histopathological evidence of infection.
  • Two patients who underwent spinal surgery with implant placement experienced infection relapse.
  • Seven patients showed rapid improvement with antimicrobial therapy alone.

Conclusions:

  • Propionibacterium acnes vertebral osteomyelitis can present with atypical clinical and diagnostic findings.
  • Clinicians must consider P. acnes as a potential pathogen, especially after invasive spinal procedures, and be aware of its variable presentation.

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