RESUMEN
Propionibacterium acnes colonizes the lipid-rich sebaceous glands of the skin. This preferential anaerobic bacterium is easily identified if cultures are prolonged. It is involved in the inflammation process of acne, but until recently, it was neglected in other clinical presentations. Despite a reported low virulence, the new genomic, transcriptomic, and phylogenetic studies have allowed better understanding of this pathogen's importance that causes many chronic and recurrent infections, including orthopedic and cardiac prosthetic, and breast or eye implant-infections. These infections, facilitated by the ability of P. acnes to produce a biofilm, require using anti-biofilm active antibiotics such as rifampicin. The antibiogram of P. acnes is not systematically performed in microbiology laboratories because of its susceptibility to a wide range of antibiotics. However, in the last 10 years, the rate of antibiotic-resistant bacteria has increased, especially for macrolides and tetracyclines. Recently, rpoB gene mutations conferring resistance to rifampicin have been also reported. Thus in case of a biofilm growth mode, the therapeutic strategy should be discussed, according to the resistance phylotype and phenotype so as to optimize the treatment of these severe infections.
Asunto(s)
Enfermedades Transmisibles Emergentes , Infecciones por Bacterias Grampositivas/microbiología , Propionibacterium acnes/patogenicidad , Acné Vulgar/microbiología , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Proteínas Bacterianas/fisiología , Técnicas de Tipificación Bacteriana , Biopelículas , Implantes de Mama/efectos adversos , Implantes de Mama/microbiología , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , ADN Bacteriano/genética , Farmacorresistencia Bacteriana Múltiple/genética , Endoftalmitis/etiología , Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/etiología , Infecciones Bacterianas del Ojo/microbiología , Genoma Bacteriano , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/transmisión , Interacciones Huésped-Patógeno , Humanos , Lentes Intraoculares/efectos adversos , Lentes Intraoculares/microbiología , Pruebas de Sensibilidad Microbiana/métodos , Filogenia , Propionibacterium acnes/clasificación , Propionibacterium acnes/efectos de los fármacos , Propionibacterium acnes/genética , Propionibacterium acnes/aislamiento & purificación , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/microbiología , Virulencia/genéticaRESUMEN
The purpose of this study was to compare the diagnostic accuracy for the detection of infection between the culture of fluid obtained by sonication (SFC) and the culture of peri-implant tissues (PITC) in patients with early and delayed implant failure, and those with unsuspected and suspected septic failure. It was hypothesised that SFC increases the diagnostic accuracy for infection in delayed, but not early, implant failure, and in unsuspected septic failure. The diagnostic accuracy for infection of all consecutive implants (hardware or prostheses) that were removed for failure was compared between SFC and PITC. This prospective study included 317 patients with a mean age of 62.7 years (9 to 97). The sensitivity for detection of infection using SFC was higher than using PITC in an overall comparison (89.9% versus 67%, respectively; p < 0.001), in unsuspected septic failure (100% versus 48.5%, respectively; p < 0.001), and in delayed implant failure (88% versus 58%, respectively; p < 0.001). PITC sensitivity dropped significantly in unsuspected compared with suspected septic failure (p = 0.007), and in delayed compared with early failure (p = 0.013). There were no differences in specificity. Sonication is mainly recommended when there is implant failure with no clear signs of infection and in patients with delayed implant failure. In early failure, SFC is not superior to PITC for the diagnosis of infection and, therefore, is not recommended as a routine diagnostic test in these patients.