Which Cutibacterium (Propionibacterium) infections are associated with orthopedic conditions?

Updated: Dec 03, 2019
  • Author: Sajeev Handa, MBBCh, BAO, LRCSI, LRCPI; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

C acnes is frequently implicated in anaerobic arthritis in association with prosthetic joints. In rare cases, it has also been found to be responsible for osteomyelitis and prosthetic vascular graft infections.

Spinal osteomyelitis is an infection of the vertebral body and/or the intervertebral space and can be associated with indwelling hardware. It may present acutely, with delayed onset, or, most frequently, late (years) following spinal surgery. The rate of C acnes infection following spinal surgery is generally low but increases to up to 12% of all infections when instrumentation is used. [6]

C acnes has been isolated from involved joints in rare cases of rheumatoid arthritis and chronic juvenile arthritis, presumably as a result of bacterial inoculation, usually during infiltration (injection).

C acnes has been implicated in certain spondyloarthropathies associated with florid acne vulgaris, in which it was isolated from bone foci and joints. [9]

C acnes has been implicated in infections following rotator cuff repair, as well as an outbreak of postoperative shoulder infections linked to a ventilation system. The shoulder appears to have a propensity for C acnes, and the bacterium should not be considered a contaminant. [1] In a review performed by Millett et al on 10 patients presenting with pain (average age, 57 y) with Cacnes following shoulder surgery, it was found that at the time of confirmation of the diagnosis, clinical signs of infection were absent. C-reactive protein and the erythrocyte sedimentation rates were inconsistently elevated. Cultures took an average of 7 days to confirm growth. Of note, the average time from surgery to diagnosis was 1.8 years. All the patients ended up undergoing irrigation and debridement and received antibiotic treatment for 6 weeks. [10]


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