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Significance of Propionibacterium acnes-positive samples in spinal instrumentation
Pascale Bémer1, S Corvec, S Tariel
1Department of Microbiology-Hygiene, Hospital University, Nantes, France. pascale.bemer@chu-nantes.fr
Study Design:
A retrospective study about Propionibacterium acnes infections after Cotrel-Dubousset (CD) instrumentation.
Objectives:
To analyze the significance of P. acnes-positive deep samples after CD.
Summary Of Background Data:
The diagnosis of spinal infections to P. acnes after CD is difficult.
Methods:
Patients with revision surgery and at least 1 P. acnes-positive deep sample, between 2000 and 2006 were included. Group A had 1 revision surgery and group B had 2 successive revision surgeries, with P. acnes-positive deep samples. Group A was divided into 2 subgroups according to the peroperative macroscopic aspect, subgroup A1 with septic tissues, subgroup A2 without septic tissues. The biologic characteristics of the patients and the surgical and medical treatments were assessed.
Results:
Sixty-eight patients were included, 60 in group A (A1 = 33, A2 = 27) and 8 in group B. Group A: 26 patients had 1 or 2 P. acnes-positive samples and 34 had at least 3 P. acnes-positive samples. Histology showed chronic inflammatory changes. C-reactive protein value median rate was 42 (A1) and 5 mg/L (A2). Twenty-two patients had a complete implant removal (14 with antibiotics, A1 = 12, A2 = 2). Nine patients had a total implant replacement (7 with antibiotics). Twenty-two patients had a partial implant removal (17 with antibiotics, A1 = 5, A2 = 12). Seven A1 patients had an irrigation and debridement (6 with antibiotics). The evolution was favorable for 28 patients. Seven patients had a documented sepsis. Group B: during the first revision, 8 patients had a partial implant removal (2 with antibiotics); during the second revision, all patients received antibiotics 4 of whom had a total implant removal. The long-term evolution was favorable for 6 patients.
Conclusion:
P. acnes infection of spinal instrumentation is difficult to diagnose. Results of at least 4 deep sample cultures, histology, and C-reactive protein values must be compared to the peroperative macroscopic aspect.
Insights
Diagnosing Propionibacterium acnes spinal infections after Cotrel-Dubousset instrumentation is challenging. Combining deep sample cultures, histology, and CRP values with surgical findings improves diagnosis and treatment outcomes.
Area of Science:
- Spinal surgery
- Infectious disease
- Orthopedic instrumentation
Background:
- Propionibacterium acnes (P. acnes) spinal infections following Cotrel-Dubousset (CD) instrumentation present diagnostic challenges.
- Early and accurate diagnosis is crucial for effective management and patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic significance of P. acnes-positive deep samples in patients undergoing revision surgery after CD instrumentation.
- To correlate microbiological findings with clinical presentation and treatment strategies.
Main Methods:
- A retrospective study included patients with P. acnes-positive deep samples undergoing revision surgery between 2000 and 2006.
- Patients were categorized into Group A (1 revision) and Group B (2 successive revisions).
- Group A was further divided based on intraoperative findings (septic vs. non-septic tissues), and various treatment modalities were assessed.
Main Results:
- Sixty-eight patients were analyzed; 60 in Group A and 8 in Group B.
- Histological examination revealed chronic inflammatory changes.
- Treatment outcomes varied, with complete implant removal, partial removal, total replacement, and irrigation and debridement all utilized, often in conjunction with antibiotics. Favorable outcomes were observed in 28 patients in Group A and 6 in Group B.
Conclusions:
- Diagnosing P. acnes spinal infections post-CD instrumentation is complex.
- Integrating results from multiple deep sample cultures (at least 4), histology, and C-reactive protein levels with intraoperative macroscopic assessment is recommended for accurate diagnosis and guiding treatment.
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