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Propionebacterium acnes in cultures from ventriculo-peritoneal shunts: infection or contamination?
H Westergren1, V Westergren, U Forsum
1Department of Neurosurgery, University Hospital, Uppsala, Sweden.
Abstract:
We have examined the accuracy of our present CSF sampling technique in 14 referred patients with suspect shunt dysfunction. The study was performed comparing culture results from shunt reservoir punctures and sham samples from skin tissue fluid close to the reservoirs. Propionebacterium acnes (P acnes) was found in five of fifteen cultures from reservoir punctures and in five of fifteen sham procedures. Positive cultures correlated in two cases. Thirteen of the fourteen patients included in the study were followed clinically and their symptoms disappeared without antibiotic or surgical treatment. One patient was treated surgically. We conclude that bacterial growth in cultures from shunt reservoirs in cases with P acnes should be interpreted with great caution, as our findings indicate that they may be skin contaminations.
Insights
Cerebrospinal fluid (CSF) shunt cultures positive for Propionibacterium acnes (P acnes) may indicate skin contamination, not infection. Most patients with positive cultures improved without treatment, suggesting caution in interpreting these results.
Area of Science:
- Neurosurgery
- Infectious Disease
- Clinical Microbiology
Background:
- Shunt dysfunction is a common complication in patients with hydrocephalus.
- Accurate diagnosis of shunt infection is crucial for appropriate management.
- Propionibacterium acnes is a common contaminant in neurosurgical procedures.
Purpose of the Study:
- To evaluate the diagnostic accuracy of cerebrospinal fluid (CSF) sampling technique for shunt infections.
- To determine the significance of Propionibacterium acnes (P acnes) detection in CSF shunt cultures.
Main Methods:
- Compared culture results from CSF shunt reservoir punctures with sham skin tissue fluid samples.
- Included 14 patients with suspected shunt dysfunction.
- Followed patients clinically after sampling.
Main Results:
- Propionibacterium acnes (P acnes) was detected in 5/15 reservoir cultures and 5/15 sham cultures.
- Positive cultures correlated in only two cases.
- 13/14 patients improved without antibiotic or surgical intervention.
Conclusions:
- Bacterial growth, particularly P acnes, in CSF shunt cultures should be interpreted cautiously.
- Findings suggest that positive P acnes cultures may represent skin contamination.
- Rethinking diagnostic criteria for shunt infections is warranted.