Article: Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection.
The Journal of antimicrobial chemotherapy
2007 Volume 60, Issue 5, Page(s) 1097–1103
Abstract: Background: Propionibacterium acnes is increasingly recognized as a cause of post-neurosurgical ... neurosurgical procedures: 27 (96%) post-craniotomy. The median time from surgery to presentation was 54 days (range 12-1 ... infection. This review of patients with P. acnes neurosurgical infection was carried out in order ...
| Abstract | Background: Propionibacterium acnes is increasingly recognized as a cause of post-neurosurgical infection. This review of patients with P. acnes neurosurgical infection was carried out in order to determine clinical characteristics and outcomes in relation to duration of antimicrobial treatment. Methods: We retrospectively reviewed the charts of consecutive patients with P. acnes isolated from neurosurgical specimens from 1 January 1999 to 30 June 2005. We defined P. acnes neurosurgical infection as isolation of P. acnes alone from a sterile neurosurgical site in a patient who clinically improved following treatment with an appropriate antibiotic. Results: We identified 28 patients with definite P. acnes neurosurgical infection; median age 49 years (range 23-77); 15 (54%) male. All patients had prior neurosurgical procedures: 27 (96%) post-craniotomy. The median time from surgery to presentation was 54 days (range 12-1,578). Eighteen out of 28 (64%) patients who met the definition of neurosurgical infection had Gram-positive bacilli seen in at least one surgical specimen compared with only 2/56 (4%) patients who did not meet the definition (P < 0.0001). Intravenous benzyl penicillin +/- oral penicillin VK was the most common treatment. The median duration of antibiotic treatment for intracranial infection was 29 days. Five of nine patients who had extracranial bone-flap-associated infection had <or=7 days of intravenous treatment and were cured. Two patients had relapse or reinfection.<br />Conclusions: P. acnes neurosurgical infection often presents in an indolent fashion. Gram-positive bacilli on Gram stain should not be discounted as a contaminant in neurosurgical specimens. Associated bone flaps should be removed. Intravenous benzyl penicillin +/- oral penicillin VK remains effective treatment. |
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| MeSH term(s) | Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Female ; Gram-Positive Bacterial Infections/diagnosis ; Gram-Positive Bacterial Infections/drug therapy ; Gram-Positive Bacterial Infections/microbiology ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/adverse effects ; Osteomyelitis/drug therapy ; Osteomyelitis/microbiology ; Postoperative Complications/diagnosis ; Postoperative Complications/drug therapy ; Postoperative Complications/microbiology ; Propionibacterium acnes/isolation & purification ; Propionibacterium acnes/physiology ; Retrospective Studies ; Surgical Wound Infection/diagnosis ; Surgical Wound Infection/drug therapy ; Surgical Wound Infection/microbiology | ||||||||||
| Chemical Substances | Anti-Bacterial Agents | ||||||||||
| Language | English | ||||||||||
| Publishing date | 2007-11 | ||||||||||
| Publishing country | England | ||||||||||
| Document type | Journal Article | ||||||||||
| ZDB-ID | 191709-2 | ||||||||||
| ISSN | 1460-2091 ; 0305-7453 | ||||||||||
| ISSN (online) | 1460-2091 | ||||||||||
| ISSN | 0305-7453 | ||||||||||
| DOI | 10.1093/jac/dkm351 | ||||||||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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