InfectionPostoperative discitis due to Propionibacterium acnes: a case report and review of the literature
Introduction
Postoperative discitis is a rare but potentially devastating complication of lumbar discectomy. The incidence of postoperative discitis is reported between 0% and 3.0% [10] and between 0.7% and 0.8% with antibiotic prophylaxis [8]. Possible etiologies include hematogenous spread and direct inoculation [13]. Most cases are due to more virulent organisms such as Staphylococcus aureus and Streptococcus milleri [12]. Propionibacterium acnes, a common skin anaerobe, is an exceedingly rare cause of postoperative discitis, with only a few cases reported in the literature. We report a case of postoperative discitis due to P acnes in a patient with severe psoriasis.
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Case report
A 64-year-old male with a history of psoriasis presented with clinical signs and symptoms and imaging studies consistent with a herniated nucleus pulposis at the L5-S1 disc space. His past medical history was also notable for aortic stenosis (status post aortic valve replacement), type II diabetes mellitus, and coronary artery disease. He underwent a routine discectomy (See Fig. 1 for preoperative magnetic resonance imaging [MRI]), which was complicated by an intraoperative dural tear and a
Discussion
Postoperative discitis is a relatively rare but potentially serious complication of discectomy. Incidence varies from 0% to 3.0% with poor subsequent outcomes [10]. The etiology of postoperative discitis is likely due to direct inoculation of virulent organisms intraoperatively, although hematogenous spread is an alternative possibility [13]. The usual pathogenetic organisms are S aureus or epidermidis [10] or streptococci [1]. Risk factors include age, chronic malnutrition, brittle diabetes,
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A postoperative brain abscess due to Propionibacterium acnes in an immunocompetent adult with incidental discovery
2022, Annals of Medicine and SurgeryCitation Excerpt :It has been postulated as the causative agent of inflammatory acne. Several reports in the literature showed that it may cause endocarditis, discitis, osteomyelitis, and central nervous system involvement including meningitis, subdural empyema and cerebral abscesses [8–10]. Intracranial infections due to P. acnes are not common.
Post-operative spondylodiscitis due to Propionibacterium acnes: A case report
2017, NeurochirurgieCitation Excerpt :Uckay et al. [4] reported a mean delay of 34 months between spinal surgery and the onset of disease. However, a few cases have been reported where there was a much shorter delay: 3 weeks for Harris et al. [5] and 3 months for Pers et al. [6]. P. acnes is a gram-positive anaerobe and a commensal bacterium of mucosa and skin, which explains the risk of direct inoculation during surgery.
Postprocedural discitis of the vertebral spine: challenges in diagnosis, treatment and prevention
2012, Journal of Hospital InfectionCitation Excerpt :Over the last two decades, this bacterium has been described as causing a wide range of infections including endocarditis, endophthalmitis and discitis.31 P. acnes is increasingly recognized as a cause of discitis.9–11,20,28 In a review of 29 cases of spondylodiscitis from Switzerland and France, together with a review of the literature, infection with this bacterium was found to be more likely in patients in the fifth and sixth decades of life, to be associated with low-grade or no fever, and to be correlated with a previous invasive procedure in 97% of patients.9
Identification, typing and characterisation of Propionibacterium strains from healthy mucosa of the human stomach
2011, International Journal of Food MicrobiologyCitation Excerpt :P. acnes is also thought to be an opportunistic pathogen. It has been implicated in postoperative and device-related infections (Harris et al., 2005) as well as in a number of other conditions such as sarcoidosis, synovitis, pustulosis, endocarditis, endophthalmitis, hyperostosis and osteitis (Ishige et al., 2005; Leyden, 2001; Perry and Lambert, 2005). Infections generally occur in immunocompromised patients and newborns; they are less common in previously healthy individuals.