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Prevalence of Propionibacterium acnes in Intervertebral Discs of Patients Undergoing Lumbar Microdiscectomy: A Prospective Cross-Sectional Study
Journal article   Open access

Prevalence of Propionibacterium acnes in Intervertebral Discs of Patients Undergoing Lumbar Microdiscectomy: A Prospective Cross-Sectional Study

Manu N Capoor, Filip Ruzicka, Tana Machackova, Radim Jancalek, Martin Smrcka, Jonathan E Schmitz, Marketa Hermanova, Jiri Sana, Elleni Michu, John C Baird, …
PloS one, v 11(8), pp e0161676-e0161676
2016
PMID: 27536784
url
https://doi.org/10.1371/journal.pone.0161676View
Published, Version of Record (VoR) Open

Abstract

Prevalence Prospective Studies Age Factors Cross-Sectional Studies Intervertebral Disc Degeneration - surgery Intervertebral Disc - microbiology Humans Middle Aged Risk Factors Diskectomy - statistics & numerical data Intervertebral Disc - surgery Diskectomy - methods Male Intervertebral Disc Degeneration - complications Gram-Positive Bacterial Infections - epidemiology Lumbar Vertebrae - surgery Intervertebral Disc Degeneration - microbiology Gram-Positive Bacterial Infections - microbiology Adult Female Gram-Positive Bacterial Infections - complications Propionibacterium acnes Real-Time Polymerase Chain Reaction
The relationship between intervertebral disc degeneration and chronic infection by Propionibacterium acnes is controversial with contradictory evidence available in the literature. Previous studies investigating these relationships were under-powered and fraught with methodical differences; moreover, they have not taken into consideration P. acnes' ability to form biofilms or attempted to quantitate the bioburden with regard to determining bacterial counts/genome equivalents as criteria to differentiate true infection from contamination. The aim of this prospective cross-sectional study was to determine the prevalence of P. acnes in patients undergoing lumbar disc microdiscectomy. The sample consisted of 290 adult patients undergoing lumbar microdiscectomy for symptomatic lumbar disc herniation. An intraoperative biopsy and pre-operative clinical data were taken in all cases. One biopsy fragment was homogenized and used for quantitative anaerobic culture and a second was frozen and used for real-time PCR-based quantification of P. acnes genomes. P. acnes was identified in 115 cases (40%), coagulase-negative staphylococci in 31 cases (11%) and alpha-hemolytic streptococci in 8 cases (3%). P. acnes counts ranged from 100 to 9000 CFU/ml with a median of 400 CFU/ml. The prevalence of intervertebral discs with abundant P. acnes (≥ 1x103 CFU/ml) was 11% (39 cases). There was significant correlation between the bacterial counts obtained by culture and the number of P. acnes genomes detected by real-time PCR (r = 0.4363, p<0.0001). In a large series of patients, the prevalence of discs with abundant P. acnes was 11%. We believe, disc tissue homogenization releases P. acnes from the biofilm so that they can then potentially be cultured, reducing the rate of false-negative cultures. Further, quantification study revealing significant bioburden based on both culture and real-time PCR minimize the likelihood that observed findings are due to contamination and supports the hypothesis P. acnes acts as a pathogen in these cases of degenerative disc disease.

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