Propionibacterium avidum as an Etiological Agent of Prosthetic Hip Joint Infection

PLoS One. 2016 Jun 29;11(6):e0158164. doi: 10.1371/journal.pone.0158164. eCollection 2016.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Female
  • Genome, Bacterial
  • Hip Prosthesis*
  • Humans
  • Male
  • Multigene Family
  • Phenotype
  • Phylogeny
  • Polymorphism, Single Nucleotide
  • Polysaccharides / chemistry
  • Postoperative Complications
  • Propionibacterium / isolation & purification*
  • Prosthesis-Related Infections / microbiology*
  • Skin / pathology

Substances

  • Polysaccharides

Grants and funding

This work was supported by grants from the Foundation for Medical Research at Örebro University Hospital (Nyckelfonden) and the Research committee of Örebro University, Region Örebro County (Ref.199021). The funders had no role in study design, data collection and analysis, decsion to publish, or preparation of the manuscript.