Propionibacterium acnes Host Inflammatory Response During Periprosthetic Infection Is Joint Specific

Abstract

Background

Propionibacterium acnes (P. acnes) has become increasingly recognized as a cause of periprosthetic joint infection (PJI).

Questions/Purposes

It is not currently known if the clinical presentation of P. acnes varies depending on the joint being infected.

Methods

We retrospectively reviewed patients infected with P. acnes after total hip, knee, and shoulder arthroplasty from two institutions. Patients were classified as having a PJI based on the Musculoskeletal Infection Society criteria and were excluded if they had a polymicrobial culture. Patient demographics, preoperative laboratory values, and microbiology data were analyzed.

Results

Eighteen knees, 12 hips, and 35 shoulders with a P. acnes PJI were identified. Median ESR was significantly higher in the knee (38.0 mm/h, IQR 18.0–58.0) and hip (33.5 mm/h, IQR 15.3–60.0) groups compared to the shoulder group (11.0 mm/h, IQR 4.5–30.5). C-reactive protein levels were higher in the knee (2.0 mg/dl, IQR 1.3–8.9) and hip (2.4 mg/dl, IQR 0.8–4.9) groups compared to the shoulder group (0.7 mg/dl, IQR 0.6–1.5). Median synovial fluid WBC was significantly higher in the knee group than shoulder group (19,950 cells/mm3, IQR 482–60,063 vs 750 cells/mm3, IQR 0–2825, respectively). Peripheral blood WBC levels were similar between groups, as was mean time of P. acnes growth in culture. Clindamycin resistance was present in all groups.

Conclusion

The manner in which a patient with P. acnes PJI presents is joint specific. Inflammatory markers were significantly higher in the knee and hip groups compared to the hip and shoulder groups, and long hold anaerobic cultures up to 14 days are necessary to accurately identify this organism.

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Correspondence to Scott R. Nodzo MD.

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Conflict of Interest

Scott R. Nodzo, MD, K. Keely Boyle, MD, Samrath Bhimani, BS, and Andy O. Miller, MD have declared that they have no conflict of interest. Geoffrey H. Westrich, MD, reports personal fees from Stryker, DJ Orthopaedics, and Mallinckrodt Pharmaceuticals, other from Exactech, outside the work. Thomas R. Duquin, MD, reports personal fees from Zimmer Biomet, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was waived from all patients for being included in the study.

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Level of Evidence: Prognostic Study Level III

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Nodzo, S.R., Boyle, K.K., Bhimani, S. et al. Propionibacterium acnes Host Inflammatory Response During Periprosthetic Infection Is Joint Specific. HSS Jrnl 13, 159–164 (2017). https://doi.org/10.1007/s11420-016-9528-2

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Keywords

  • Propionibacterium acnes
  • arthroplasty
  • periprosthetic infection
  • clinical presentation