Presence of Propionibacterium acnes in patients with aseptic bone graft resorption after cranioplasty: preliminary evidence for low-grade infection

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  • Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Munich, Germany
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OBJECTIVE

Autologous bone graft reimplantation remains the standard treatment after decompressive hemicraniectomy. Unfortunately, some patients present with signs of bone resorption without any visible signs of infection; the reasons remain unknown. Contamination with Propionibacterium acnes has been discussed as a potential source of the osteolytic process. The aim of this study was to investigate the microbial spectrum detected in samples of grafts from patients with aseptic bone resorption and compare them to septic bone graft infections in order to identify P. acnes as the specific pathogen of aseptic bone resorption.

METHODS

The authors retrospectively reviewed all patients treated for aseptic bone resorption between 2012 and 2017 in their neurosurgical department. Septic infections were used as a control group to gain information on the present bacterial spectrum. Perioperative data such as demographics, number of surgeries, and complications were assessed and compared with the microbiological analyses conducted in order to detect differences and potential sources for aseptic bone resorption and possible differences in bacterial contamination in septic and aseptic bone infection.

RESULTS

In total, 38 patients underwent surgery between 2012 and 2017 for septic bone infection—14 for aseptic bone resorption. In 100% of the septic bone infection cases in which bone flap removal was needed, bacteria could be isolated from the removed bone flap (55% Staphylococcus aureus, 13.2% Enterococcus faecalis, and 18.4% Staphylococcus epidermidis). The microbial spectrum from samples of aseptic bone flaps with resorption was examined in 10 of 14 patients and revealed contamination with P. acnes in 40% (n = 4, the other 6 bone grafts were sterile), especially in sonication analysis, whereas visible septic bone infection was mainly caused by S. aureus without detection of P. acnes.

CONCLUSIONS

Aseptic bone resorption may be caused by low-grade infections with P. acnes. However, further analysis needs to be conducted in order to understand its clinical relevance and treatment perspective.

ABBREVIATIONS SAH = subarachnoid hemorrhage; SSI = surgical site infection; TBI = traumatic brain injury.

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Contributor Notes

Correspondence Sandro M. Krieg: Technische Universität München, Germany. sandro.krieg@tum.de.

INCLUDE WHEN CITING Published online August 30, 2019; DOI: 10.3171/2019.5.JNS191200.

Disclosures Dr. Krieg is a consultant for Spineart Deutschland GmbH and Nexstim Plc and received honoraria from Medtronic and Carl Zeiss Meditec. Drs. Krieg and Meyer received research grants from and are consultants for Brainlab AG. Dr. Meyer received honoraria, consulting fees, and research grants from Medtronic, icotec ag, and Relievant Medsystemy Inc.; honoraria and research grants from Ulrich Medical; honoraria and consulting fees from Spineart Deutschland GmbH and DePuy Synthes; and royalties from Spineart Deutschland GmbH.

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