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Propionibacterium Acnes Infections After Cranial Neurosurgery

Published online by Cambridge University Press:  02 December 2014

Michael E. Kelly ,
Daryl R. Fourney ,
Raphael Guzman ,
Venkatraman Sadanand ,
Robert W. Griebel  and
Stephen E. Sanche
Michael E. Kelly*
Affiliation:
Department of Neurosurgery, Stanford University Medical Center, Stanford, California
Daryl R. Fourney
Affiliation:
Division of Neurosurgery, Royal University Hospital and University of Saskatchewan, Saskatoon, SK, Canada
Raphael Guzman
Affiliation:
Department of Neurosurgery, Stanford University Medical Center, Stanford, California
Venkatraman Sadanand
Affiliation:
Division of Neurosurgery, Royal University Hospital and University of Saskatchewan, Saskatoon, SK, Canada
Robert W. Griebel
Affiliation:
Division of Neurosurgery, Royal University Hospital and University of Saskatchewan, Saskatoon, SK, Canada
Stephen E. Sanche
Affiliation:
Division of Infectious Diseases, Department of Medicine, Royal University Hospital and University of Saskatchewan, Saskatoon, SK, Canada
*
Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA, 94305-5327.
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Abstract:

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Background:

Propionibacterium acnes (P. acnes) is a relatively avirulent organism that is part of the normal skin flora. Most patient isolates are considered contaminants but, in a small subset of patients, particularly in the post-neurosurgery setting, the organism can cause significant infections. We reviewed our experience with the occurrence and management of P. acnes infections after cranial neurosurgical procedures over a five-year period.

Methods:

Patients with positive cultures for P. acnes between 1996 and 2001 were identified by review of the Saskatoon Health Region microbiology laboratory database. Of the 141 positive cultures, a review of hospital records identified six patients with P. acnes infections after neurosurgical procedures. A review of the literature related to P. acnes associated CNS infections was conducted.

Results:

All patients had undergone a craniotomy or burrhole placement, and one patient had received prior radiotherapy. There were no P. acnes-related ventriculoperitoneal shunt infections. All patients presented with scalp swelling and three had purulent discharge. Symptoms occurred more than two months after the initial surgery in five of six patients, while one patient developed symptoms three years post-operatively. Management for all patients included removal of the craniotomy flap and treatment with parenteral antibiotics, followed in most cases by oral antibiotics. A good response without relapse of infection was seen in five patients; one patient had recurrent infection after cranioplasty.

Conclusion:

P. acnes is a rare but important cause of infection after craniotomy. Wound debridement, removal of the bone flap and adequate antibiotic coverage result in cure in the majority of patients.

Résumé:

RÉSUMÉ:Contexte:

Le Corynebacterium acnes est un organisme relativement avirulent qui fait partie de la flore cutanée normale. On considère que la plupart des isolats de patients sont des contaminants. Cependant chez un petit sous-groupe de patients, particulièrement après une neurochirurgie, ce microorganisme peut causer des infections importantes. Nous revoyons notre expérience sur une période de 5 ans de l’infection à C. acnes et de son traitement après une neurochirurgie crânienne.

Méthodes:

Nous avons identifié les patients dont la culture démontrait la présence de C. acnes entre 1996 et 2001 au moyen d’une revue de la base de données du laboratoire de microbiologie de la région sanitaire de Saskatoon. 141 cultures positives ont été identifiées, dont six provenaient de patients ayant subi une neurochirurgie. Nous avons effectué une revue de la littérature sur les infections à C. acnes du SNC.

Résultats:

Tous les patients avaient subi une craniotomie ou un trou de trépan et un patient avait reçu de la radiothérapie avant l’intervention. Il n’y avait pas de cas relié à une dérivation ventriculopéritonéale. Les patients ont tous présenté un gonflement du cuir chevelu et trois présentaient un écoulement purulent. Les symptômes sont survenus plus de 2 mois après la chirurgie chez cinq des six patients alors que chez l’autre ils sont survenus trois ans plus tard. Tous les patients ont reçu le même traitement, soit l’ablation du volet osseux avec antibiothérapie par voie parentérale suivie, dans la plupart des cas, d’antibiothérapie par voie orale. Cinq patients ont bien répondu au traitement, sans récidive. Un patient a eu une récidive après une cranioplastie.

Conclusions:

Le C. acnes est une cause d’infection rare mais importante après la craniotomie. Le débridement et l’ablation du volet osseux ainsi qu’une antibiothérapie adéquate assurent la guérison chez la majorité des patients.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 3 , August 2006 , pp. 292 - 295
Copyright
Copyright © The Canadian Journal of Neurological 2006

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