Genomic Analysis of Cutibacterium acnes Strains Isolated from Prosthetic Joint Infections

Cutibacterium acnes is a common cause of prosthetic joint infections (PJIs). The C. acnes population can be divided into six main phylotypes (IA1, IA2, IB, IC, II and III) that are associated with different clinical conditions and normal skin. A single-locus sequence typing (SLST) scheme can distinguish ten main SLST types: A-E (all IA1), F (IA2), G (IC), H (IB), K (II), L (III). We genome-sequenced and compared 16 strains of C. acnes isolated from healthy skin (n = 4) and PJIs (n = 12), including six PJI cases with a good outcome (four shoulder PJIs, one hip PJI, one knee PJI) and six with infection relapse (three shoulder PJIs, three hip PJIs). The sequenced strains belonged to four different phylotypes (IA1, IA2, IB and II) and seven different SLST types. All five type IB strains (all SLST type H1) were PJI isolates (three hip PJIs, two shoulder PJIs), and four of these caused infection relapse (three hip PJIs, one shoulder PJI). Isolates from PJI cases with a good outcome belonged to three different phylotypes (IA, IB, II). Interestingly, four strains (three strains from PJI cases with good outcome and one strain from healthy skin) contained a linear plasmid; these strains belonged to different SLST types (A1, C1, F4, H1) and were isolated in three different hospitals. This study suggests that type IB strains have the potential to cause infection relapse, in particular regarding hip PJIs. Moreover, our study revealed that strains belonging to the same SLST type can differ in their accessory genome in different geographic locations, indicative of microevolution.

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Staphylococcus saccharolyticus Associated with Prosthetic Joint Infections: Clinical Features and Genomic Characteristics

Pathogens ◽

10.3390/pathogens10040397 ◽

2021 ◽

Vol 10 (4) ◽

pp. 397

Author(s):

Bo Söderquist ◽

Mastaneh Afshar ◽

Anja Poehlein ◽

Holger Brüggemann

Keyword(s):

Aseptic Loosening ◽

Normal Skin ◽

Low Grade ◽

Pathogenic Potential ◽

Long Term Outcome ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Cutibacterium Acnes

The anaerobic coagulase-negative staphylococcal species Staphylococcus saccharolyticus is a member of the normal skin microbiota. However, S. saccharolyticus is rarely found in clinical specimens and its pathogenic potential is unclear. The clinical data of prosthetic hip (n = 5) and shoulder (n = 2) joint implant-associated infections where S. saccharolyticus was detected in periprosthetic tissue specimens are described. The prosthetic hip joint infection cases presented as “aseptic” loosening and may represent chronic, insidious, low-grade prosthetic joint infections (PJIs), eventually resulting in loosening of prosthetic components. All cases were subjected to one-stage revision surgery and the long-term outcome was good. The shoulder joint infections had an acute onset. Polymicrobial growth, in all cases with Cutibacterium acnes, was found in 4/7 patients. All but one case were treated with long-term administration of beta-lactam antibiotics. Whole-genome sequencing (WGS) of the isolates was performed and potential virulence traits were identified. WGS could distinguish two phylogenetic clades (clades 1 and 2), which likely represent distinct subspecies of S. saccharolyticus. Little strain individuality was observed among strains from the same clade. Strains of clade 2 were exclusively associated with hip PJIs, whereas clade 1 strains originated from shoulder PJIs. It is possible that strains of the two clades colonize different skin habitats. In conclusion, S. saccharolyticus has the potential to cause PJIs that were previously regarded as aseptic loosening of prosthetic joint devices.

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Cutibacterium acnes (formerly Propionibacterium acnes) isolated from prosthetic joint infections is less susceptible to oxacillin than to benzylpenicillin

Journal of Bone and Joint Infection ◽

10.7150/jbji.30954 ◽

2019 ◽

Vol 4 (3) ◽

pp. 106-110 ◽

Cited By ~ 2

Author(s):

Sara Ridberg ◽

Bengt Hellmark ◽

Åsa Nilsdotter ◽

Bo Söderquist

Keyword(s):

Minimum Inhibitory Concentration ◽

Prophylactic Treatment ◽

Inhibitory Concentration ◽

Propionibacterium Acnes ◽

Joint Infections ◽

Randomized Controlled Studies ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Cutibacterium Acnes ◽

Antibiotic Agents

Abstract. Introduction: The frequency of prosthetic joint infections (PJIs) due to Cutibacterium acnes (formerly Propionibacterium acnes) is increasing, especially shoulder PJIs. The recommended antibiotic prophylaxis for hip and knee arthroplasties is beta-lactam antibiotics, predominantly cephalosporins. However, for example in Sweden, isoxazolyl-penicillin cloxacillin is used. No specific recommendations for shoulder arthroplasties are available. The aim of the present study was to determine the minimum inhibitory concentration (MIC) values for different antibiotics for C. acnes; and, more specifically, to compare the MIC values for benzylpenicillin and oxacillin.Materials and methods: Minimum inhibitory concentration (MIC) values for nine different antibiotic agents were obtained by gradient test (Etest) using strains of C. acnes (n= 57) isolated from PJIs from shoulders (n=31), hips (n=21), and knees (n=5).Results: All isolates had low MIC values for most of the tested antibiotic agents, and showed a wild type MIC distribution. The exception was clindamycin with 9% of the isolates displaying decreased susceptibility. The MIC values obtained for benzylpenicillin were significantly lower than the MIC values for isoxazolyl-penicillin (oxacillin).Conclusion: These in vitro results indicate that benzylpenicillin might be a more effective prophylactic treatment to prevent shoulder PJIs caused by C. acnes. However, further studies on the subject are needed, and the effectiveness of the prophylactic treatment should be evaluated using randomized controlled studies and/or register-based studies.

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Experience With the Use of the MicroDTTect Device for the Diagnosis of Low-Grade Chronic Prosthetic Joint Infections in a Routine Setting

Frontiers in Medicine ◽

10.3389/fmed.2021.565555 ◽

2021 ◽

Vol 8 ◽

Author(s):

Camille Kolenda ◽

Jérôme Josse ◽

Cécile Batailler ◽

Allison Faure ◽

Alice Monteix ◽

...

Keyword(s):

Treatment Time ◽

Prosthetic Material ◽

Low Grade ◽

Microbiological Diagnosis ◽

Conventional Culture ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Cutibacterium Acnes ◽

Commercial Device

Background: In prosthetic joint infections (PJIs), identification of the causative microorganisms is critical to successfully adapt and optimize treatment. However, microbiological diagnosis of PJIs remains a challenge notably because bacteria are embedded in biofilm adhered to the prosthetic material. Recently, dithiothreitol (DTT) treatment of prosthesis has been proposed as a new strategy to release bacteria from biofilm and to improve the yield of microbiological diagnosis. In this study, we evaluated the interest of a commercial device using DTT, the MicroDTTect system (Heraeus, Hanau, Germany), for the diagnosis of low-grade chronic PJIs, compared to the conventional culture of periprosthetic tissue (PPT) samples.Methods: Twenty patients undergoing a surgery procedure for removal of prosthetic material because of a suspicion of low-grade PJI without pre-operative microbiological documentation were included (NCT04371068). Bacteriological results using the fluid obtained after prosthesis treatment with the MicroDTTect system were compared to results obtained with conventional culture of PPT samples.Results: All the bacteria considered as responsible for PJIs recovered from culture of PPT samples were also detected using the MicroDTTect device. For one patient, an additional bacterial isolate (Staphylococcus haemolyticus) suspected to be involved in a polymicrobial PJI was identified using DTT treatment. Time to positivity of the cultures was also reduced using the MicroDTTect system, notably in case of Cutibacterium acnes infection. However, probable bacterial contaminants were found (MicroDTTect system, n = 5; PPT samples, n = 1).Conclusion: This study showed that DTT treatment of the prosthetic component using the MicroDTTect device could improve the microbiological diagnosis of low-grade PJIs.

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Ceftriaxone treatment of spondylodiscitis and other serious infections with Cutibacterium acnes

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa259 ◽

2020 ◽

Vol 75 (10) ◽

pp. 3046-3048

Author(s):

Theo S Tiltnes ◽

Michala Kehrer ◽

Harriet Hughes ◽

Trefor E Morris ◽

Ulrik S Justesen

Keyword(s):

Clinical Data ◽

Surveillance Data ◽

Once Daily ◽

Joint Infections ◽

Prosthetic Joint ◽

Serious Infections ◽

Prosthetic Joint Infections ◽

Cutibacterium Acnes ◽

Daily Dose ◽

Systemic Infections

Abstract Objectives To establish testing and treatment recommendations for a ceftriaxone once-daily dose regimen for systemic infections with Cutibacterium acnes. Methods A review of the literature and a retrospective evaluation of patients diagnosed with C. acnes spondylodiscitis and treated with ceftriaxone were performed. Ceftriaxone and penicillin MICs were determined for C. acnes isolates from blood and biopsies and the epidemiological cut-off (ECOFF) was determined with surveillance data from the UK Anaerobe Reference Laboratory in Cardiff. Results Limited clinical data exist from endocarditis and prosthetic joint infections using treatment with ceftriaxone 2 g once daily for C. acnes with ceftriaxone MICs ≤0.5 mg/L. In this case study, five patients were successfully treated with ceftriaxone as part of the treatment for spondylodiscitis with C. acnes. Ceftriaxone and penicillin MICs of the C. acnes isolates from the patients were 0.016–0.125 mg/L and 0.012–0.032 mg/L, respectively. The ceftriaxone ECOFF was 0.5 mg/L and the penicillin ECOFF was 0.25 mg/L based on available surveillance data. Conclusions From the data presented in this study it would be acceptable to consider treatment with a once-daily dose of ceftriaxone 2 g for systemic infections, including endocarditis, spondylodiscitis and prosthetic joint infections with C. acnes using a clinical breakpoint of ≤0.5 mg/L (the ECOFF). However, clinical data are still limited and the response of patients treated with ceftriaxone for serious infections with C. acnes should be monitored closely.

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Clonal diversity of Cutibacterium acnes (formerly Propionibacterium acnes) in prosthetic joint infections

Anaerobe ◽

10.1016/j.anaerobe.2019.04.011 ◽

2019 ◽

Vol 59 ◽

pp. 54-60

Author(s):

C. Liew-Littorin ◽

H. Brüggemann ◽

S. Davidsson ◽

Å. Nilsdotter-Augustinsson ◽

B. Hellmark ◽

...

Keyword(s):

Propionibacterium Acnes ◽

Clonal Diversity ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Cutibacterium Acnes

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Lower activation of caspase-1 by Staphylococcus epidermidis isolated from prosthetic joint infections compared to commensals

Journal of Bone and Joint Infection ◽

10.7150/jbji.21567 ◽

2018 ◽

Vol 3 (1) ◽

pp. 10-14 ◽

Cited By ~ 1

Author(s):

Emeli Månsson ◽

Berolla Sahdo ◽

Åsa Nilsdotter-Augustinsson ◽

Eva Särndahl ◽

Bo Söderquist

Keyword(s):

Staphylococcus Epidermidis ◽

Normal Skin ◽

Human Neutrophils ◽

Caspase 1 ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Skin Flora ◽

Number Of Individuals ◽

Active Caspase

Abstract. Nosocomial sequence types of Staphylococcus epidermidis dominate in prosthetic joint infections. We examined caspase-1 activation in human neutrophils after incubation with Staphylococcus epidermidis isolated from prosthetic joint infections and normal skin flora. Active caspase-1 was lower after incubation with isolates from prosthetic joint infections than after incubation with commensal isolates. Both host and isolate dependent differences in active caspase-1 were noted. Our results indicate that there might be a host-dependent incapacity to elicit a strong caspase-1 response towards certain strains of S. epidermidis. Further experiments with a larger number of individuals are warranted.

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Cutibacterium acnes Septic Arthritis of the Nonoperated Knee: A Case Report

The Surgery Journal ◽

10.1055/s-0037-1603970 ◽

2017 ◽

Vol 03 (03) ◽

pp. e107-e109 ◽

Cited By ~ 1

Author(s):

Kelechi Okoroha ◽

Michael Gabbard ◽

Jamal Fitts ◽

Trevor Banka

Keyword(s):

Septic Arthritis ◽

Clinical Judgment ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Cutibacterium Acnes ◽

Antibiotic Management ◽

Uncommon Case ◽

Selection For ◽

Septic Knee Arthritis

Abstract Cutibacterium (Propionibacterium) acnes, a gram-positive bacillus with low pathogenicity, is an uncommon but known cause of prosthetic joint infections, particularly related to shoulder surgery. C. acnes, however, is an extremely rare pathogen in the nonoperated knee joint. This report details an uncommon case of C. acnes septic knee arthritis after multiple intra-articular steroid injections in a 56-year-old male patient. After an indolent presentation and late diagnosis, the patient underwent surgical debridement with IV antibiotic management. This case illustrates that intra-articular corticosteroid injections for the management of osteoarthritis are not without risk. Literature supporting their use remains limited and clinicians should use proficient clinical judgment for appropriate patient selection for these injections. Vigilance following injections or aspirations of the knee should be maintained to identify the indolent clinical presentation of C. acnes septic arthritis.

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