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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 90 - 90
1 Dec 2018
MOLECULAR TYPING SHOWS THE NEED FOR A NEW DEFINITION OF CUTIBACTERIUM ACNES ORTHOPAEDIC DEVICE-RELATED INFECTIONS
El Sayed F Roux A Bauer T Nich C Sapriel G Dinh A Gaillard J Rottman M
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Aim

Cutibacterium acnes, a skin commensal, is responsible for 5–10% of prosthetic joint infections (PJI). All current microbiological definitions of PJI require two or more identical commensal isolates to be recovered from the same procedure to diagnose PJI and rule out contamination. Unlike coagulase negative staphylococci, C.acnes shows a highly stereotypical susceptibility profile making impossible to phenotypically assess the clonal relationship of isolates. In order to determine the clonal relationship of multiple C.acnes isolates recovered from arthroplasty revisions, we analyzed by multi-locus sequence typing (MLST) C.acnes isolates grown from orthopedic device-related infections (ODRI) in a reference center for bone and joint infection.

Methods

Laboratory records from January 2009 to January 2014 were searched for monomicrobial C.acnes ODRI with growth of C. acnes in at least 2 intraoperative and/or preoperative samples. Clinical, biological and demographic information was collected from hospital charts. All corresponding isolates biobanked in cryovials (−80°C) were subcultured on anaerobic blood agar, and identification confirmed by MALDI-TOF-MS. C.acnes isolates were typed using the MLST scheme described by Lomholt et al. Plasmatic pre-operative C-reactive protein (CRP) levels were determined using DimensionEXL (Siemens). A threshold of 10 mg/L was used to determine serologically positive ODRIs from negatives.

Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 34 - 34
1 Dec 2017
THE ACUTE PRESENTATION OF PROSTHESIS JOINT INFECTIONS CAN BE DECEIVING: WHOLE GENOME SEQUENCING AS A DIAGNOSTIC TOOL
El Sayed F Gruber A Sapriel G Fawal N Bauer T Heym B Dupont C Hello SL Gaillard J Rottman M
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Aim

According to Tsukuyama classification, late acute hematogenous prosthesis joint infections (PJI) should be treated with debridement and implant retention (DAIR). We report here a recurrent Salmonella Dublin hip prosthesis infection. Through this case, we show how a recurrence of chronic PJI may have an acute clinical presentation leading to an inadequate surgical treatment.

Method

Case report. On May 2011, a 74-year-old woman with bilateral hip prostheses (implanted in 1998 (right) and 2001 (left)), was admitted to intensive care for sepsis and pain of her left hip. Blood cultures and a joint aspiration of the left hip yielded pure cultures of S.Dublin. The patient had a recent history of febrile diarrhea after consuming dubious meat. The patient underwent DAIR followed by a six-week antibiotherapy. Three years later, she presented to the emergency room for an acute onset febrile PJI of the right hip. The patient underwent DAIR of the right hip. Blood cultures, joint aspiration fluid, and all intraoperative periprosthetic tissue samples yielded S.Dublin. Colonoscopy and abdomen ultrasound were negative. The patient received two weeks of intravenous combined antibiotherapy followed by oral antibiotics for further 10 weeks. Six weeks post operatively, the surgical wound was healed and the patient walked normally. One year later, the patient was referred by her primary care practitioner for night fevers without local signs or dysfunction of her prostheses. Radioleucoscintigraphy showed right hip inflammation. Bilateral hip biopsies were nevertheless performed, yet S. Dublin was recovered solely from the right hip biopsy. A one-stage exchange of the right hip was performed. All intraoperative periprosthetic tissue samples yielded S.Dublin. A six-week-combined antibiotherapy was undertaken. One year later, the patient appeared free of infection and walked normally.

Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 77 - 77
1 Dec 2017
CLONAL RELATIONSHIP OF PROPIONIBACTERIUM ACNES ISOLATES RECOVERED FROM BONE AND JOINT INFECTIONS: DOES MICROBIOLOGICAL DEFINITION OF PROSTHESIS JOINT INFECTIONS APPLY TO THIS MICROORGANISM?
El Sayed F Roux A Rabès J Mazancourt P Bauer T Gaillard J Rottman M
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Aim

Propionibacterium acnes is a skin commensal colonizing the deeper structures of the pilous bulb. It is responsible for 5–10% of lower limb prosthetic joint infections (PJI) but accounts for as many as 50% of shoulder arthroplasty infections. P. acnes PJIs characteristically feature limited systemic inflammation, limited polymorphonuclear infiltration and clinical signs compatible with aseptic loosening. All current microbiological definitions of PJI require two or more identical commensal isolates to be recovered from the same procedure to diagnose PJI to increase specificity and rule out contamination. Whereas the antimicrobial susceptibility patterns of coagulase negative staphylococci are highly polymorphic and commonly allow the ready distinction of unrelated strains, P. acnes shows a highly stereotypical susceptibility profile and it is impossible to phenotypically assess the clonal relationship of isolates. In order to determine the clonal relationship of multiple P. acnes isolates recovered from arthroplasty revisions, we analyzed by multi-locus sequence typing (MLST) P. acnes isolates grown from PJI in a reference center for bone and joint infection.

Method

We retrospectively selected all cases of microbiologically documented monomicrobial PJI caused by P. acnes diagnosed in our center from January 2009 to January 2014. Microorganisms were identified by MALDI-TOF mass spectrometry (Bruker Daltonics). All corresponding P.acnes isolates biobanked in cryovials frozen at −80°C were subcultured on anaerobic blood agar, DNA extracted by freeze-thawing and bead-milling, and typed according to the 9 gene MLST scheme proposed by Lomholt HB. and al.