Which is the best treatment for prosthetic joint infections due to Propionibacterium acnes: need for further biofilm in vitro and experimental foreign-body in vivo studies?
Abstract
Sir—We read with a great interest the recent paper by Jacobs et al. (2015) concerning the treatment of prosthetic joint infections (PJI) caused by Propionibacterium acnes and the associated comments (Bayston and Ashraf 2016). The first paper suggests that combination therapy with rifampicin is not more effective than therapy without rifampicin. We demonstrated previously in vitro and in an animal foreign body infection model that the minimal eradication biofilm concentration (MBEC) was the lowest with rifampicin (16 mg/L) alone compared with penicillin G, daptomycin, ceftriaxone, levofloxacin, vancomycin, and clindamycin (Furustrand et al. 2012). However, we have reported the emergence of rifampicin-resistant P. acnes strains in vitro (Furustrand et al. 2013) and in vivo (Furustrand et al. 2015). Clindamycin had a higher MBEC (128 mg/L) in our biofilm model. Physicians and microbiologists should keep in mind that clindamycin is a bacteriostatic drug which was not as effective as rifampicin in our experience. Though most non-dermatological P. acnes clinical isolates are susceptible to most of the antibiotics, it remains important to perform systematic susceptibility testing. While clindamycin resistance is well known in acne (Ross et al. 2001), between 7% and 9% resistance were reported for P. acnes isolates from shoulder surgery (Crane et al. 2013) and orthopedic implant-associated infections (knee, hip or shoulder prostheses) (Khassebaf et al. 2015), respectively.
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