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Propionibacterium spp. in prosthetic joint infections: a diagnostic challenge

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Propionibacterium species are common inhabitants of the skin and usually non-pathogenic for humans. However, Propionibacterium spp. can occasionally cause infections, but are estimated to play a minor role in prosthetic joint infections (PJI). The relative frequency of these anaerobes and their potential to cause surgical site infection may be clinically underestimated. An unknown proportion of these infections might be missed, since little is known about their clinical presentation, and since growth of Propionibacterium spp. in diagnostic samples is often interpreted as contamination. Thus, a hypothesis is being tested, stating that Propionibacterium spp. is not as rare as often reported, and it can cause severe soft-tissue damages in PJI.

Materials and methods

In this retrospective analysis, we reviewed all PJI that had been treated in our institution from 2000 to 2005, and assessed the relative frequency of those caused by Propionibacterium spp. In the identified cases, features that led to the diagnosis (clinical, laboratory, radiological, microbiological and histopathological characteristics) were analysed.

Results

Of 139 cases of prosthetic joint infections, 8(6%) were caused by Propionibacterium spp. Seven patients complained of pain as the main symptom, and four had damaged soft-tissue. Analysis of the diagnostic procedures showed a median of 39% positive samples out of all cultured biopsies (median 9.5 biopsies per case), with a median time-to-positivity of 8 days. Results of histopathological examinations of the periprosthetic tissue correlated well with the clinical courses.

Conclusions

Our data suggest that Propionibacterium associated prosthetic joint infections occur at a relative frequency that is comparable to many other pathogens. Clinical signs are generally subtle, but the spectrum includes also significant soft-tissue damages. In this study, a median of 9.5 biopsies per case, an incubation time of 14 days, and the aid of histopathological examinations proved to be helpful in establishing the diagnosis.

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Acknowledgments

We like to thank Docent Bengt Gårdlund (Department of Infectious Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden) for his helpful comments. We are grateful to the laboratory technician from our Unit of Microbiology and Anna Bächtold from our library for superb assistance. This study was presented at the 92nd Conference of the German Society of Orthopedics and Orthopedic Surgery, Berlin, Germany, 2–6 October 2006.

Conflict of interest statement

None of the authors has a conflict of interest. Ethical Board Review statement: In this retrospective analysis, all data are anonymously presented, and patient consent has been received from all involved humans prior to the study.

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Authors and Affiliations

  1. Clinic of Orthopaedic Surgery, Kantonsspital, Liestal, Switzerland

    Björn Zappe & Peter E. Ochsner

  2. Unit of Infectious Diseases, Basel University Medical Clinic Liestal, Rheinstrasse 26, 4410, Liestal, Switzerland

    Werner Zimmerli & Parham Sendi

  3. Microbiology Laboratory, Kantonsspital, Liestal, Switzerland

    Susanne Graf

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  1. Björn Zappe
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  2. Susanne Graf
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  3. Peter E. Ochsner
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  4. Werner Zimmerli
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  5. Parham Sendi
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Correspondence to Parham Sendi.

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Zappe, B., Graf, S., Ochsner, P.E. et al. Propionibacterium spp. in prosthetic joint infections: a diagnostic challenge. Arch Orthop Trauma Surg 128, 1039–1046 (2008). https://doi.org/10.1007/s00402-007-0454-0

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