Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy
Year: 2017
Type: article
Study design: Observational Study
Abstract: BACKGROUND: In previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of ~25% of patients undergoing microdiscectomy, suggesting a possible link between chronic bacterial infection and disc degeneration. However, given the prominence of P. acnes as a skin commensal, such analyses often struggled to exclude the alternate possibility that these organisms represent perioperative microbiologic contamination. This investigation seeks to validate P. acnes prevalence in resected disc cultures, while providing microscopic evidence of P. acnes biofilm in the intervertebral discs. METHODS: Specimens from 368 patients undergoing microdiscectomy for disc herniation were divided into several fragments, one being homogenized, subjected to quantitative anaerobic culture, and assessed for bacterial growth, and a second fragment frozen for additional analyses. Colonies were identified by MALDI-TOF mass spectrometry and P. acnes phylotyping was conducted by multiplex PCR. For a sub-set of specimens, bacteria localization within the disc was assessed by microscopy using confocal laser scanning and FISH. RESULTS: Bacteria were cultured from 162 discs (44%), including 119 cases (32.3%) with P. acnes. In 89 cases, P. acnes was cultured exclusively; in 30 cases, it was isolated in combination with other bacteria (primarily coagulase-negative Staphylococcus spp.) Among positive specimens, the median P. acnes bacterial burden was 350 CFU/g (12 - ~20,000 CFU/g). Thirty-eight P. acnes isolates were subjected to molecular sub-typing, identifying 4 of 6 defined phylogroups: IA1, IB, IC, and II. Eight culture-positive specimens were evaluated by fluorescence microscopy and revealed P. acnes in situ. Notably, these bacteria demonstrated a biofilm distribution within the disc matrix. P. acnes bacteria were more prevalent in males than females (39% vs. 23%, p = 0.0013). CONCLUSIONS: This study confirms that P. acnes is prevalent in herniated disc tissue. Moreover, it provides the first visual evidence of P. acnes biofilms within such specimens, consistent with infection rather than microbiologic contamination.
Source: PLoS ONE
Authors: Manu N. Capoor, Filip Ruzicka, Jonathan E. Schmitz, Garth A. James, Tana Machackova, Radim Jancalek, Martin Smrcka, Radim Lipina, Fahad S. Ahmed, Todd F. Alamin, Neel Anand, John C. Baird, Nitin Bhatia, Sibel Demir-Deviren, Robert K. Eastlack, Steve Fisher, Steven R. Garfin, Jaspaul S. Gogia, Ziya L. Gokaslan, Calvin C. Kuo, Yu-Po Lee, Konstantinos Mavrommatis, Elleni Michu, Hana Noskova, Assaf Raz, Jiri Sana, A. Nick Shamie, Philip S. Stewart, Jerry L. Stonemetz, Jeffrey C. Wang, Timothy F. Witham, Michael F. Coscia, Christof Birkenmaier, Vincent A. Fischetti, Ondrej Slaby
Institutions: Central European Institute of Technology, Masaryk University, Central European Institute of Technology – Masaryk University, Rockefeller University, St. Anne's University Hospital Brno, Vanderbilt University, Montana State University, University Hospital Brno, University Hospital Ostrava, Stanford Medicine, Stanford University, Cedars-Sinai Medical Center, University of California, Irvine, University of California, San Francisco, University of California San Francisco Medical Center, Scripps Health, Scripps Clinic, University of California San Diego, Kaiser Permanente San Jose Medical Center, Brown University, Rhode Island Hospital, Kaiser Permanente, Kaiser Permanente Oakland Medical Center, University of California, Los Angeles, Johns Hopkins University, Johns Hopkins Hospital, University of Southern California, Indiana Orthopaedic Hospital, Ludwig-Maximilians-Universität München
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,382
OpenAlex ID: W2605239741