title: Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen.
abstract: Propionibacterium acnes is known primarily as a skin commensal. However, it can present as an opportunistic pathogen via bacterial seeding to cause invasive infections such as implant-associated infections. These infections have gained more attention due to improved diagnostic procedures, such as sonication of explanted foreign materials and prolonged cultivation time of up to 14 days for periprosthetic biopsy specimens, and improved molecular methods, such as broad-range 16S rRNA gene PCR. Implant-associated infections caused by P. acnes are most often described for shoulder prosthetic joint infections as well as cerebrovascular shunt infections, fibrosis of breast implants, and infections of cardiovascular devices. P. acnes causes disease through a number of virulence factors, such as biofilm formation. P. acnes is highly susceptible to a wide range of antibiotics, including beta-lactams, quinolones, clindamycin, and rifampin, although resistance to clindamycin is increasing. Treatment requires a combination of surgery and a prolonged antibiotic treatment regimen to successfully eliminate the remaining bacteria. Most authors suggest a course of 3 to 6 months of antibiotic treatment, including 2 to 6 weeks of intravenous treatment with a beta-lactam. While recently reported data showed a good efficacy of rifampin against P. acnes biofilms, prospective, randomized, controlled studies are needed to confirm evidence for combination treatment with rifampin, as has been performed for staphylococcal implant-associated infections.
authors: Department of Microbial Pathogenesis, Dental School, University of Maryland, Baltimore, Maryland, USA.
authors: Yvonne
authors: Y
authors: Achermann
authors: R. M. Alden Research Laboratory, Santa Monica, CA, USA, and David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors: Ellie J C
authors: EJ
authors: Goldstein
authors: Laboratorium voor Farmaceutische Microbiologie, Ghent University, Ghent, Belgium.
authors: Tom
authors: T
authors: Coenye
authors: Department of Microbial Pathogenesis, Dental School, University of Maryland, Baltimore, Maryland, USA Department of Microbiology and Immunology, School of Medicine, University of Maryland, Baltimore, Maryland, USA mshirtliff@umaryland.edu.
authors: Mark E
authors: ME
authors: Shirtliff
mesh_terms: D000818:Animals; D018441:Biofilms; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy; D054884:Host-Pathogen Interactions / Q000276:immunology; D006801:Humans; D054892:Metagenome; D064307:Microbiota; D011425:Propionibacterium acnes / Q000145:classification / Q000472:pathogenicity / Q000502:physiology*; D019736:Prostheses and Implants / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy; D014774:Virulence