Artikel
Presence of cutibacterium acnes in healthy bone specimens of the skull in cranial neurosurgery – pathogenic, contamination or colonisation
Nachweis von Cutibacterium acnes in gesundem Knochenmehl – Krankheitswert, Kontamination oder Besiedlung?
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Autoren
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Vicki Butenschoen
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Mirja Seifert
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Bernhard Meyer
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Sandro Krieg
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Cutibacterium acnes (formerly Propionibacterium) has been discussed to provoke low-grade infections leading to aseptic bone resorption in patients undergoing autologous cranioplasty. While its presence has been described in osteolytic processes, its pathogenic role remains a matter of debate. Our aim was to perform a control study investigating the presence of bacteria in the calvaria of patients undergoing cranial surgery without visible signs of high- or low-grade infections.
Methods: We performed a prospective monocentric study enrolling patients prior to an operative neurosurgical treatment including a craniotomy. Informed consent was obtained and the bone meal accumulated during the craniotomy was collected and sent for microbiological analysis. Patients with clinical or radiological signs of septic or aseptic bone infections were excluded. We assessed perioperative data such as antibiotic prophylaxis, comorbidities and complications such as wound healing disorders.
Results: In total, bone specimen from 42 patients were analyzed. Patients were stratified in 2 groups: first surgery (26 patients) and patients undergoing cranial surgery for tumor recurrence (16 patients). In 29/42 patients (69%), the microbiological analysis revealed the presence of bacteria (13/16 preoperated and 16/26 first operated patients). The analysis mainly revealed the presence of Cutibacterium acnes (diagnosed in first surgery patients in 16/16 patients). Findings in the preoperated group included: Cutibacterium acnes (n: 8), Staphylococcus (Staph.) epidermidis (n: 1) and Enterobacter cloacae (n: 2) as well as Staph. capitis and Staph. warneri (both n: 1). In 5/42 patients we detected wound healing difficulties on the further clinical course, 4/5 patients had a Cutibacterium acnes presence. None of the patients suffered from bone resorption on the further course of treatment.
Conclusion: In more than half of the patients, we detected the presence of bacteria in the bone meal extracted without signs of infections. Reoperation did not make a difference. Cutibacterium acnes as the most frequent germ might be causative for a high number of wound healing problems. Whether this can be avoided by early targeted postoperative antibiotics needs to be examined.
