Arthroplasty Infection by Priopionibacterium granulosum Treated With Reimplantation Despite Ongoing Purulent-Appearing Fluid Collection

ArticleinThe Journal of arthroplasty 28(1) · April 2012with7 Reads
DOI: 10.1016/j.arth.2012.03.004 · Source: PubMed
Abstract
We present the first case of infection in a native or prosthetic joint by Propionibacterium granulosum in which a patient developed symptoms of prosthetic hip infection 5 years after primary surgery. The patient required multiple operative debridements to eradicate the infection and was successfully reimplanted despite an ongoing purulent-appearing, although sterile, fluid collection at the time of reimplantation. There is no clinical or laboratory evidence of infection at 3 years post-reimplantation, and the patient has a well-functioning total hip arthroplasty. P granulosum is a low-virulence but highly-inflammatory organism. It seems to produce a large fluid collection that may require multiple debridements. To our knowledge, there are no reported cases of native or prosthetic joint infection from P granulosum. We present the first case here.
    • "P. acnes is now well-established as a possible etiologic agent of prosthetic joint infections (PJIs) [7,8], especially prosthetic shoulder joint infections [9]. Other Propionibacterium spp., such as Propionibacterium granulosum, has also occasionally been described as a cause of PJIs [10]. Propionibacterium avidum has been reported as a cause of soft tissue infections, such as various abscesses [11][12][13]and of bone and joint infections in at least three cases [14], but has not previously been associated with PJIs. "
    [Show abstract] [Hide abstract] ABSTRACT: Propionibacterium acnes is well-established as a possible etiologic agent of prosthetic joint infections (PJIs). Other Propionibacterium spp. have occasionally been described as a cause of PJIs, but this has not previously been the case for P. avidum despite its capacity to form biofilm. We describe two patients with prosthetic hip joint infections caused by P. avidum. Both patients were primarily operated with an anteriorly curved skin incision close to the skin crease of the groin, and both were obese. Initial treatment was performed according to the DAIR procedure (debridement, antibiotics, and implant retention). In case 1, the outcome was successful, but in case 2, a loosening of the cup was present 18 months post debridement. The P. avidum isolate from case 1 and two isolates from case 2 (obtained 18 months apart) were selected for whole genome sequencing. The genome of P. avidum obtained from case 1 was approximately 60 kb larger than the genomes of the two isolates of case 2. These latter isolates were clonal with the exception of SNPs in the genome. All three strains possessed the gene cluster encoding exopolysaccharide synthesis. P. avidum has a pathogenic potential and the ability to cause clinically relevant infections, including abscess formation, in the presence of foreign bodies such as prosthetic joint components. Skin incision in close proximity to the groin or deep skin crease, such as the anteriorly curved skin incision approach, might pose a risk of PJIs by P. avidum, especially in obese patients.
    Full-text · Article · Jun 2016