Publication details

Propionibacterium acnes biofilm is present in intervertebral discs of patients undergoing microdiscectomy

Authors

MANU NATH CAPOOR externista RŮŽIČKA Filip SCHMITZ Jonathan E. JAMES Garth A. MACHÁČKOVÁ Táňa JANČÁLEK Radim SMRČKA Martin LIPINA Radim FAHAD AHMED externista ALAMIN Todd F. ANAND Neel BAIRD John C. BHATIA Nitin DEMIR-DEVIREN Sibel EASTLACK Robert K. FISHER Steve GARFIN Steven R. GOGIA Jaspaul S. GOKASLAN Ziya L. KUO Calvin C. LEE Yu-Po MAVROMMATIS Konstantinos PONECHAL MICHU Elleni NOSKOVÁ Hana RAZ Assaf ŠÁNA Jiří SHAMIE A. Nick STEWART Philip S. STONEMETZ Jerry L. WANG Jeffrey C. WITHAM Timothy F. COSCIA Michael F. BIRKENMAIER Christof FISCHETTI Vincent A. SLABÝ Ondřej

Year of publication 2017
Type Article in Periodical
Magazine / Source Plos one
MU Faculty or unit

Central European Institute of Technology

Citation
Web http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174518
Doi http://dx.doi.org/10.1371/journal.pone.0174518
Field Immunology
Keywords LOW-BACK-PAIN; SAPHO SYNDROME; MODIC CHANGES; LUMBAR SPINE; SARCOIDOSIS; INFECTIONS; ASSOCIATION; CONTAMINATION; INVOLVEMENT; DIAGNOSIS
Description Background In previous studies, Propionibacterium acnes was cultured from intervertebral disc tissue of similar to 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 - similar to 20,000 CFU/g). Thirtyeight 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.
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