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Significance of Propionibacterium acnes-Positive Samples in Spinal Instrumentation

Bémer, Pascale, PhD*; Corvec, S*; Tariel, S*; Asseray, N; Boutoille, D; Langlois, C; Tequi, B*; Drugeon, H*; Passuti, N§; Touchais, S§

doi: 10.1097/BRS.0b013e31818e28dc
Clinical Case Series

Study Design. A retrospective study about Propionibacterium acnes infections after Cotrel–Dubousset (CD) instrumentation.

Objectives. To analyze the significance of P. acnes-positive deep samples after CD.

Summary of Background Data. The diagnosis of spinal infections to P. acnes after CD is difficult.

Methods. Patients with revision surgery and at least 1 P. acnes-positive deep sample, between 2000 and 2006 were included. Group A had 1 revision surgery and group B had 2 successive revision surgeries, with P. acnes-positive deep samples. Group A was divided into 2 subgroups according to the peroperative macroscopic aspect, subgroup A1 with septic tissues, subgroup A2 without septic tissues. The biologic characteristics of the patients and the surgical and medical treatments were assessed.

Results. Sixty-eight patients were included, 60 in group A (A1 = 33, A2 = 27) and 8 in group B. Group A: 26 patients had 1 or 2 P. acnes-positive samples and 34 had at least 3 P. acnes-positive samples. Histology showed chronic inflammatory changes. C-reactive protein value median rate was 42 (A1) and 5 mg/L (A2). Twenty-two patients had a complete implant removal (14 with antibiotics, A1 = 12, A2 = 2). Nine patients had a total implant replacement (7 with antibiotics). Twenty-two patients had a partial implant removal (17 with antibiotics, A1 = 5, A2 = 12). Seven A1 patients had an irrigation and debridement (6 with antibiotics). The evolution was favorable for 28 patients. Seven patients had a documented sepsis. Group B: during the first revision, 8 patients had a partial implant removal (2 with antibiotics); during the second revision, all patients received antibiotics 4 of whom had a total implant removal. The long-term evolution was favorable for 6 patients.

Conclusion. P. acnes infection of spinal instrumentation is difficult to diagnose. Results of at least 4 deep sample cultures, histology, and C-reactive protein values must be compared to the peroperative macroscopic aspect.

Sixty-eight patients with Cotrel–Dubousset instrumentation had at least 1 deep sample positive to Propionibacterium acnes. Thirty-four patients had at least 3 P. acnes-positive samples. The optimum treatment associated a total implant removal with antibiotics. Failures occurred when implant was partially removed or when antibiotics were not used.

From the *Department of Microbiology-Hygiene; †Referents in Antibiotherapy; and Departments of ‡Anesthesiology and §Orthopedic Surgery, Hospital University, Nantes, France.

Acknowledgment date: October 19, 2007. Revision date: May 15, 2008. Acceptance date: June 25, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Pascale Bemer, Department of Microbiology-Hygiene, CHU Hôtel-Dieu, 9 quai Moncousu, 44093 Nantes cedex 1, France; Email:

© 2008 Lippincott Williams & Wilkins, Inc.