title: Antibiotics for the eradication of Propionibacterium acnes biofilms in surgical infection.
abstract: OBJECTIVE
  Propionibacterium acnes is increasingly recognized as a cause of delayed infection after spinal instrumentation or shunting for hydrocephalus. Biofilm development by this organism has recently been demonstrated. We therefore investigated the effect of two different courses of three antibiotics (penicillin, rifampicin and linezolid) on mature P. acnes biofilms in vitro. Outcomes were eradication or regrowth after withdrawal of antibiotics, simulating successful treatment and relapse.
  
  
  METHODS
  P. acnes biofilms were grown on titanium discs for 6 days until mature, then exposed to the antibiotics for either 7 or 14 days before sonication and culture. Further, discs were similarly exposed, but after each course, they were reincubated for a further 9 days to check for regrowth.
  
  
  RESULTS
  Penicillin, linezolid and linezolid plus rifampicin eradicated P. acnes biofilms after 14 days, but only penicillin had this effect after 7 days. 'Relapse' was prevented only by 14 day courses of penicillin or linezolid plus rifampicin, but not by linezolid alone.
  
  
  CONCLUSIONS
  For P. acnes spinal instrumentation infections, either penicillin or linezolid plus rifampicin might be equally effective. For shunt infections, as penicillin does not give therapeutic cerebrospinal fluid concentrations, rifampicin plus linezolid might be the treatment of choice. Linezolid alone appears not to be as effective as penicillin against P. acnes biofilms.
authors.affiliation: Biomaterials-Related Infection Group, School of Medical and Surgical Sciences, University of Nottingham, Nottingham, UK. roger.bayston@nottingham.ac.uk
authors.forename: Roger
authors.initials: R
authors.lastname: Bayston
authors.forename: Bryar
authors.initials: B
authors.lastname: Nuradeen
authors.forename: Waheed
authors.initials: W
authors.lastname: Ashraf
authors.forename: Brian J C
authors.initials: BJ
authors.lastname: Freeman
mesh_terms: D000081:Acetamides / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D018441:Biofilms / Q000187:drug effects* / Q000254:growth & development; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D015169:Colony Count, Microbial; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D000069349:Linezolid; D008826:Microbial Sensitivity Tests; D023303:Oxazolidinones / Q000494:pharmacology*; D010400:Penicillin G / Q000494:pharmacology*; D011425:Propionibacterium acnes / Q000187:drug effects* / Q000254:growth & development; D012293:Rifampin / Q000494:pharmacology*; D013530:Surgical Wound Infection / Q000188:drug therapy*; D014025:Titanium / Q000737:chemistry
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014025:Titanium; D000069349:Linezolid; D010400:Penicillin G; D012293:Rifampin