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Propionibacterium avidum as an Etiological Agent of Prosthetic Hip Joint Infection
Örebro University, School of Medical Sciences. Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Institute of Hygiene, University of Münster, Münster, Germany.
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2016 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 6, article id e0158164Article in journal (Refereed) Published
Abstract [en]

Propionibacterium acnes is well-established as a possible etiologic agent of prosthetic joint infections (PJIs). Other Propionibacterium spp. have occasionally been described as a cause of PJIs, but this has not previously been the case for P. avidum despite its capacity to form biofilm. We describe two patients with prosthetic hip joint infections caused by P. avidum. Both patients were primarily operated with an anteriorly curved skin incision close to the skin crease of the groin, and both were obese. Initial treatment was performed according to the DAIR procedure (debridement, antibiotics, and implant retention). In case 1, the outcome was successful, but in case 2, a loosening of the cup was present 18 months post debridement. The P. avidum isolate from case 1 and two isolates from case 2 (obtained 18 months apart) were selected for whole genome sequencing. The genome of P. avidum obtained from case 1 was approximately 60 kb larger than the genomes of the two isolates of case 2. These latter isolates were clonal with the exception of SNPs in the genome. All three strains possessed the gene cluster encoding exopolysaccharide synthesis.

P. avidum has a pathogenic potential and the ability to cause clinically relevant infections, including abscess formation, in the presence of foreign bodies such as prosthetic joint components. Skin incision in close proximity to the groin or deep skin crease, such as the anteriorly curved skin incision approach, might pose a risk of PJIs by P. avidum, especially in obese patients.

Place, publisher, year, edition, pages
San Francisco: Public Library of Science , 2016. Vol. 11, no 6, article id e0158164
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-51157DOI: 10.1371/journal.pone.0158164ISI: 000378859400034PubMedID: 27355425Scopus ID: 2-s2.0-84977672350OAI: oai:DiVA.org:oru-51157DiVA, id: diva2:945335
Note

Funding Agencies:

Foundation for Medical Research at Orebro University Hospital (Nyckelfonden)

Region Örebro County 199021

Research committee of Örebro University

Available from: 2016-07-01 Created: 2016-07-01 Last updated: 2021-09-07Bibliographically approved
In thesis
1. Prosthetic Joint Infection of the Hip: Cause and Effect
Open this publication in new window or tab >>Prosthetic Joint Infection of the Hip: Cause and Effect
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Every year, 18 000 patients in Sweden and more than 1 million worldwide undergo total hip arthroplasty (THA). The operation is of great benefit to patients, but is associated with several complications. Prosthetic joint infections (PJIs) are among the most common complications, and can be devastating in terms of suffering for the patient and cost for the healthcare provider. The aim of this thesis was to investigate different aspects of PJIs in order to gain a better understanding of the causes and effects of infection. 

Four studies were conducted covering genomic analysis of the causative organism, identification of risk factors for failure of treatment, evaluation of a national infection control program aimed at reducing the burden of infections (PRISS: Prosthesis-related infections shall be stopped), and examination of the long-term impact of a PJI on the patient’s health through patient-reported measurement questionnaires.

The main findings were as follows. Commensal bacteria such as Cutibacterium avidum have the potential to cause PJIs, and should be specially accounted for when performing hip surgery with an anterior approach. S. aureus is both a commensal and a pathogen with invasive capacity, and the commensal strains do not differ from the PJI strains regarding prevalence of virulence genes and clonal complexes. The genomic traits of pathogens had no impact on treatment success or eradication of infection in S. aureus PJIs The long-term effects of a PJI in the hip include increased mortality, lower quality of life, and decreased hip function. The incidence of PJIs was higher following the PRISS project. Increasing risk factors contributing to PJI explain the increasing incidence of PJI after primary THA.

In conclusion, PJIs of the hip have multifactorial causes which are difficult to reduce, and long-term effects are severe.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2021. p. 98
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 246
Keywords
Prosthetic joint infection, infection, arthroplasty, hip, Staphylococcus aureus, Cutibacterium avidum, hip, outcome, PROM
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-92269 (URN)978-91-7529-398-1 (ISBN)
Public defence
2021-10-01, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
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Supervisors
Available from: 2021-06-09 Created: 2021-06-09 Last updated: 2023-08-29Bibliographically approved

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Wildeman, PeterSöderquist, Bo

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