Abstract
BackgroundThe definition criteria and clinical characteristics of implant-associated infection (IAI) caused by Cutibacterium (formerly Propionibacterium) spp. are poorly known. We analyzed microbiologically proven Cutibacterium orthopedic IAI in a prospective cohort.MethodsPatients with periprosthetic joint infections (PJI) and fixation device–associated infections (FDAI) caused by Cutibacterium spp. were prospectively included. IAI was defined by significant growth of Cutibacterium spp. and presence of at least one non-microbiological criterion for infection. The McNemar’s chi-squared or binomial test was used to compare the performance of diagnostic tests.ResultsOf 121 patients with Cutibacterium IAI, 62 patients (51%) had PJI and 59 (49%) had FDAI. 109 infections (90%) were caused by C. acnes and 12 (10%) by C. avidum. The median time from implantation until diagnosis of infection was 15.7 months (interquartile range, 5–46.5 months). Clinical local signs were present in 30 patients (28%) and radiological implant loosening in 64 patients (63%). Culture sensitivity of sonication fluid was 84%, of peri-implant tissue 84% and of synovial or peri-implant fluid 56% after 14 days of incubation.ConclusionCutibacterium IAI was diagnosed late in the disease course and presented with subtle signs. Prolonged culture incubation and implant sonication improved the poor performance of conventional microbiological tests. Due to lack of reliable diagnostic tests, Cutibacterium remains difficult to detect making the diagnosis challenging.
Highlights
Bacteria belonging to the genus Propionibacterium are gram-positive, aerotolerant anaerobic rods that reside primarily in pilosebaceous follicles and are part of the normal skin microbiome
With diagnostic techniques designed for improved diagnosis of implant-associated infections (IAI) and the use of better definition criteria for infection, Cutibacterium is increasingly recognized as true pathogen rather than contamination
From January 2012 through March 2018 consecutive episodes of IAI caused by Cutibacterium spp. were included and classified as periprosthetic joint infections (PJI) and fixation device– associated infections (FDAI)
Summary
Bacteria belonging to the genus Propionibacterium are gram-positive, aerotolerant anaerobic rods that reside primarily in pilosebaceous follicles and are part of the normal skin microbiome. With diagnostic techniques designed for improved diagnosis of implant-associated infections (IAI) and the use of better definition criteria for infection, Cutibacterium is increasingly recognized as true pathogen rather than contamination. These methods include prolonged incubation of microbiological specimens [2], application of novel techniques for biofilm detection, such as sonication of explanted materials [18] and implementation of molecular assays [19,20,21].
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