title: Propionibacterium acnes osteomyelitis occurring 23 years after craniotomy: case report and review of literature.
abstract: BACKGROUND
  Propionibacterium acnes is an uncommon pathogen in delayed surgical site infection, and its indolent course can complicate diagnosis and treatment. We report the longest delay between neurosurgery and P acnes infection reported.
  
  
  METHODS
  Asymptomatic postoperative P acnes osteomyelitis and tumor recurrence occurring 23 years after initial craniotomy. Initial presentation was of tumor recurrence only, without signs or symptoms of infection. Calvarial osteomyelitis was unexpectedly discovered intraoperatively. Craniectomy and débridement were performed, and there was prolonged antibiotic therapy.
  
  
  CONCLUSIONS
  The longest delay between neurosurgery and asymptomatic P acnes infection is reported. We review the literature for P acnes infection and discuss biofilm formation and its role in delayed surgical infection.
authors.affiliation: Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington 98195, USA. mlevitt@u.washington.edu
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.forename: Patrik
authors.initials: P
authors.lastname: Gabikian
authors.forename: Paul S
authors.initials: PS
authors.lastname: Pottinger
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Silbergeld
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000601:surgery; D002437:Cefazolin / Q000627:therapeutic use; D003399:Craniotomy / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D018908:Muscle Weakness / Q000209:etiology; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000009:adverse effects; D009837:Oligodendroglioma / Q000601:surgery; D010019:Osteomyelitis / Q000209:etiology* / Q000382:microbiology; D011425:Propionibacterium acnes; D012086:Reoperation; D013530:Surgical Wound Infection / Q000150:complications* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin