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Utility of strain typing of Propionibacterium acnes in central nervous system and prosthetic joint infections to differentiate contamination from infection: a retrospective cohort

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Abstract

The study aimed to retrospectively assess if strain typing of Propionibacterium acnes could help to distinguish between infection and contamination in isolates recovered from the central nervous system (CNS) and prosthetic joints (PJs). This was a retrospective cohort of all Propionibacterium species isolates from the Barnes-Jewish Hospital (St Louis, MO, USA) clinical microbiology laboratory from 2011 to 2014. Available frozen isolates were recovered, and strain type (IA-1, IA-2, IB, II, III, or nontypeable class A or B) was determined via polymerase chain reaction (PCR)-based methods. For CNS isolates, P. acnes was considered pathogenic if treating physicians administered ≥7 days of directed antibiotic therapy against P. acnes. During the study period, Propionibacterium species was isolated from clinical cultures 411 times. 152 isolates were available for analysis. Of the 152 isolates, 140 were confirmed to be P. acnes, 61 of which were from the CNS (45 contaminants, 16 infections). Strain type IA-1 was more common (50.0%, 8 out of 16) among CNS infections than among contaminants (22.2%, 10 out of 45). For PJ isolates 61.3% (19 out of 31) met the criteria for infection. The predominant strain type for CNS infection was IA-1 and for PJ isolates, IB. Strain type IA-1 was isolated more often in patients with CNS infections, which may indicate a predilection of this strain type to cause CNS infection. Future research should prospectively evaluate strain typing as a means of assisting in the diagnosis of CNS infections and confirm our findings.

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Acknowledgements

We thank Dr Andrew McDowell (Northern Ireland Centre for Stratified Medicine) for providing the strain types of P. acnes for quality control of the strain typing assay.

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Authors and Affiliations

  1. Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA

    J. P. Burnham & D. K. Warren

  2. Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA

    A. Shupe & C.-A. D. Burnham

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Correspondence to J. P. Burnham.

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Conflicts of interest

None of the authors report any conflicts of interest related to this manuscript. C.A.B. has received grant support from bioMerieux, Cepheid, Accelerate Diagnostics, and Theravance. D.K.W. has received grant support from Cepheid and Pfizer, and has served as a consultant for Carefusion/Benton Dickenson, Worrell, Inc., and Novaerus, Inc.

J.P.B. reports that “Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.”

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This study was approved by the Washington University School of Medicine Human Studies Committee.

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Burnham, J.P., Shupe, A., Burnham, CA.D. et al. Utility of strain typing of Propionibacterium acnes in central nervous system and prosthetic joint infections to differentiate contamination from infection: a retrospective cohort. Eur J Clin Microbiol Infect Dis 36, 2483–2489 (2017). https://doi.org/10.1007/s10096-017-3090-9

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