Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection
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Susan M Butler-Wu1, Erica M Burns, Paul S Pottinger
1Department of Laboratory Medicine, University of Washington, Seattle, Washington 98195-7110, USA. butlerwu@uw.edu
Abstract:
Propionibacterium acnes is increasingly recognized as an important agent of prosthetic joint infection (PJI). However, the optimum culture conditions for recovery of this organism from PJI specimens have not been determined. By applying a prolonged 28-day culture incubation to all periprosthetic specimens received for bacterial culture from 198 revision arthroplasty procedures, we retrospectively determined that a 13-day culture incubation period is necessary for the recovery of P. acnes from patients with PJI. Incubation beyond this period was associated with increasing recovery of nondiagnostic isolates: 21.7% of P. acnes isolates believed to be clinically unimportant were recovered after 13 days of incubation. Importantly, a diagnosis of P. acnes PJI would have been missed in 29.4% of patients had extended culture incubation been applied only to anaerobic culture media. Although specimens from P. acnes PJIs were more commonly associated with the presence of ≥ 2 culture media positive for growth, acute inflammation (≥ 5 neutrophils/high-power field) was observed in only 40% of patients with PJIs that had more than one specimen submitted for bacterial culture. These results support the need for a minimum culture incubation period of 13 days to be applied to both aerobic and anaerobic culture media for all periprosthetic specimens. Optimal recovery of infecting organisms from PJI specimens will be an important component in generating a universal definition for PJI due to indolent agents of infection, such as P. acnes.
Insights
A 13-day incubation is crucial for detecting Propionibacterium acnes (P. acnes) in prosthetic joint infections (PJIs). Extended incubation beyond this period risks identifying non-diagnostic P. acnes, potentially leading to missed PJI diagnoses.
Area of Science:
- Microbiology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Propionibacterium acnes is a significant cause of prosthetic joint infection (PJI).
- Optimal culture conditions for P. acnes recovery from PJI specimens remain undetermined.
- Current diagnostic protocols may not adequately detect P. acnes due to its slow growth.
Purpose of the Study:
- To determine the optimal culture incubation period for recovering P. acnes from prosthetic joint infection specimens.
- To evaluate the impact of extended incubation times on the diagnostic yield of P. acnes in PJIs.
- To assess the necessity of both aerobic and anaerobic culture media for P. acnes detection.
Main Methods:
- Retrospective analysis of 198 revision arthroplasty procedures with periprosthetic specimens cultured.
- Application of a prolonged 28-day culture incubation period to all specimens.
- Comparison of P. acnes recovery rates at different incubation durations (minimum 13 days).
- Evaluation of acute inflammation markers in PJI specimens.
Main Results:
- A minimum 13-day culture incubation period is necessary for P. acnes recovery in PJI.
- Incubation beyond 13 days led to the recovery of non-diagnostic P. acnes isolates (21.7%).
- Extended incubation on anaerobic media alone would have missed 29.4% of P. acnes PJI diagnoses.
- Acute inflammation was present in only 40% of PJIs with multiple positive cultures.
Conclusions:
- A minimum 13-day incubation for both aerobic and anaerobic media is essential for P. acnes PJI diagnosis.
- Extended incubation beyond 13 days may yield non-clinically significant isolates.
- Optimized culture conditions are vital for defining PJIs caused by indolent pathogens like P. acnes.
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