Introdução/Objetivo: Investigar a incidência de Cutibacterium acnes em amostras de tecidos profundos de pacientes submetidos a cirurgias limpas primárias e eletivas de ombro (artrotomia ou ...artroscopia), e caracterizar fatores de fenotípicos e genotípicos de patogenicidade associados à colonização ou infecção. Métodos: Três amostras de tecidos (tecido ósseo, tendão e bursa) foram coletadas dos pacientes e alocadas em meio tioglicolato, incubadas em jarra de anaerobiose a 37°C por 14 dias. O grupo controle incluiu amostras de voluntários saudáveis que tiveram a superfície da clavícula esfregada com swabs. Os microrganismos foram identificados por MALDI-TOF MS e confirmados por PCR com a amplificação do gene PArA-1. A filotipagem ocorreu por PCR multiplex touchdown. A sensibilidade antimicrobiana foi testada com a fita Etest e a leitura da concentração inibitória mínima das fitas seguiram as recomendações do BrCAST, 2021. Resultados: 84 pacientes foram incluídos no estudo, 54% (45/84) homens, com média idade de 51 anos (±17 anos). Sexo masculino foi a única variável associada a maior probabilidade de recuperação de C. acnes (p=0,005). Das 255 amostras de tecido avaliadas, 21.5% (55) apresentaram qualquer crescimento bacteriano e destes, o C. acnes foi identificado em 11.8% (30). Os filotipos IB e II foram predominantes em 73,3% e 23,3%, respectivamente. No grupo controle, foram identificados quatro C. acnes, sendo dois do filotipo IA2. Os isolados de C. acnes foram majoritariamente sensíveis aos antimicrobianos avaliados, com exceção da resistência intrínseca ao metronidazol (CIM >256 g/mL) em todos, um isolado com resistência à penicilina (CIM 0.64 g/mL). Duas amostras apresentaram concentrações elevadas de ciprofloxacina (CIM >32 μg/mL) e rifampicina (CIM >32 μg/mL). Nenhum paciente foi diagnosticado com infecção clínica pós-operatória causada por C. acnes em seis meses de seguimento prospectivo. Conclusão: Em pacientes submetidos à cirurgia eletiva limpa de ombro, as culturas de tecido profundo intraoperatória identifica comumente isolamentos de C. acnes, principalmente filotipos IB e II que foram associados às infecções em implantes ortopédicos. Entretanto, no presente estudo estes isolados não foram causadores de infecção pós-operatória. Outro marcador de patogenicidade como resistência aos antibióticos foi incomum. A identificação de C. acnes não impõe a necessidade imediata de tratamento quando não houver sinais de sintomas clínicos de infecção.
Acne is a chronic inflammatory disease of the sebaceous gland attached to the hair follicles. Cutibacterium acnes is a major cause of inflammation caused by acne. It is well known that C. acnes ...secretes a lipolytic enzyme to break down lipids in sebum, and free fatty acids produced at this time accelerate the inflammatory reaction. There are several drugs used to treat acne; however, each one has various side effects. According to previous studies, sulforaphene (SFEN) has several functions associated with lipid metabolism, brain function, and antibacterial and anti-inflammatory activities. In this study, we examined the effects of SFEN on bacterial growth and inflammatory cytokine production induced by C. acnes. The results revealed that SFEN reduced the growth of C. acnes and inhibited proinflammatory cytokines in C. acnes-treated HaCaT keratinocytes through inhibiting NF-κB-related pathways. In addition, SFEN regulated the expression level of IL-1α, a representative pro-inflammatory cytokine expressed in co-cultured HaCaT keratinocytes and THP-1 monocytes induced by C. acnes. In conclusion, SFEN showed antibacterial activity against C. acnes and controlled the inflammatory response on keratinocytes and monocytes. This finding means that SFEN has potential as both a cosmetic material for acne prevention and a pharmaceutical material for acne treatment.
Cutibacterium acnes (previously known as Propionibacterium acnes) is frequently found on lipid-rich parts of the human skin. While C. acnes is most known for its role in the development and ...progression of the skin disease acne, it is also involved in many other types of infections, often involving implanted medical devices. C. acnes readily forms biofilms in vitro and there is growing evidence that biofilm formation by this Gram-positive, facultative anaerobic micro-organism plays an important role in vivo and is also involved in treatment failure. In this brief review we present an overview on what is known about C. acnes biofilms (including their role in pathogenesis and reduced susceptibility to antibiotics), discuss model systems that can be used to study these biofilms in vitro and in vivo and give an overview of interspecies interactions occurring in polymicrobial communities containing C. acnes.
BACKGROUNDUnexpected positive cultures (UPCs) are frequently observed in primary shoulder arthroplasty and its clinical significance has not yet been well defined. The aim is to evaluate the UPCs in ...humeral head in primary shoulder replacement and to understand if UPCs increase in patients with risk factors for contamination (previous surgery or infiltrations).METHODSPatients undergoing total shoulder replacement were enrolled in this prospective observational study. To reduce the risk of humeral head contamination, all known procedures to reduce C. acnes burden of the skin were implemented. Patients were divided into 2 groups, namely patients who had undergone previous rotator cuff repair or infiltration and patients with no risk factors for contamination. All the humeral heads harvested were treated with Dithiothreitol, in a specific device (MicroDTTect), to increase the sensitivity of the cultures for bacterial identification. The cultures were analyzed for aerobic and anaerobic bacteria for up to 14 days.RESULTSThe UPCs positivity rate of the 80 patients in the study was 19 % (15 patients). The positivity rates for UPCs in the group with and without risk factors were 30 % (12 patients) and 7.5% (3 patients), respectively. The rate of positive culture was higher in men (87%) than in women (13%). The observed positivity was due to Cutibacterium acnes and peptoniphilus asaccarolyticus, both slow-growing anaerobes.CONCLUSIONSPatients with previous surgery or infiltrations had a 4-fold higher rate of positivity for UPCs compared with patients without previous risk factors. The higher percentage of positivity in patients with risk factors could be related to changes in the joint microenvironment after shoulder procedures. We do not know whether the presence of UPCs could be associated with the development of periprosthetic infections at longer follow-up.
A 22-year-old woman, who had undergone intracardiac repair for pulmonary valve atresia with a ventricular septal defect when she was three years old, underwent right ventricular outflow tract ...reconstruction for re-stenosis. On the 22nd postoperative day, she was admitted to our hospital with a fever. She was diagnosed as having mediastinitis with infiltration of the lung contiguous to the site of the origin on contrast computed tomographic (CT) examination. She received cefazolin and vancomycin, and drainage was performed under general anesthesia the following day. There were many white blood cells but no bacteria in the pus on Gram staining ; on anaerobic culture and enriched broth culture, gram positive rods were detected which needed to be differentiated from Actinomyces spp. ; they were finally identified as Cutibacterium acnes by means of biochemical methods, 16S rRNA gene analysis, and time of flight mass spectrometry (TOF/MS). Cefazolin and vancomycin were changed to ampicillin ; after 5 weeks, infiltration of the lung lesion was still present. Ampicillin was then changed to oral amoxicillin and continued for a total of 10 weeks. She recovered completely. To our knowledge, there is no report of a case of mediastinitis caused by C. acnes with infiltration of the lung. We needed to differentiate the pathogen from contaminants on detecting C. acnes. In this case, we concluded that it was a pathogen because of the pure culture, and identification of C. acnes in several ways. Mediastinitis caused by C. acnes can infiltrate the lung. Surgery is not necessary for the management of the infiltrated lesion ; medical management with antibiotics is adequate. Its treatment is different from that of Actinomyces spp. The period of antibiotic administration needs to be determined by evaluating the CT image, because the period for treatment of the infiltrate lesion has not been established.
Psoriasis is a chronic skin inflammation influenced by dysregulated skin microbiota, with the role of microbiota in psoriasis gaining increasing prominence. Bacterial extracellular vesicles (bEVs) ...serve as crucial regulators in the interaction between hosts and microbiota. However, the mechanism underlying the therapeutic potential of bEVs from commensal bacteria in psoriasis remains unclear. Here, we investigated the therapeutic role of Cutibacterium acnes (C. acnes)-derived extracellular vesicles (CA-EVs) in psoriasis treatment. To prolong the active duration of CA-EVs, we encapsulated them in gelatin methacrylate (GelMA) to fabricate hydrogel microspheres (CA-EVs@GHM) with sustained release properties. As GelMA degraded, CA-EVs were gradually released, maintaining a high concentration in mouse skin even 96 hours post-treatment. In human keratinocyte cells (HaCaT), CA-EVs@GHM enhanced resistance to Staphylococcus aureus (S. aureus), promoted proliferation and migration of HaCaT cells exposed to S. aureus, and significantly reduced the expression of inflammatory genes such as interleukin (IL)-6 and C-X-C motif chemokine ligand 8 (CXCL8). In vivo, CA-EVs@GHM, more potent than CA-EVs alone, markedly attenuated proinflammatory gene expression, including tumor necrosis factor (TNF), Il6, Il17a, Il22 and Il23a in imiquimod (IMQ)-induced psoriasis-like mice, and restored skin barrier function. 16S rRNA sequencing revealed that CA-EVs@GHM might provide therapeutic effects against psoriasis by restoring microbiota diversity on the back skin of mice, reducing Staphylococcus colonization, and augmenting lipid metabolism. Furthermore, flow cytometry analysis showed that CA-EVs@GHM prevented the conversion of type 2 innate lymphoid cells (ILC2) to type 3 innate lymphoid cells (ILC3) in psoriasis-like mouse skin, reducing the pathogenic ILC3 population and suppressing the secretion of IL-17 and IL-22. In summary, our findings demonstrate that the long-term sustained release of CA-EVs alleviated psoriasis symptoms by controlling the transformation of innate lymphoid cells (ILCs) subgroups and restoring skin microbiota homeostasis, thus offering a promising therapy for psoriasis treatment. STATEMENT OF SIGNIFICANCE: Cutibacterium acnes, which is reduced in psoriasis skin, has been reported to promote skin homeostasis by regulating immune balance. Compared to live bacteria, bacterial extracellular vesicles (bEVs) are less prone to toxicity and safety concerns. bEVs play a pivotal role in maintaining bacterial homeostasis and modulating the immune system. However, bEVs without sustained release materials are unable to function continuously in chronic diseases. Therefore, we utilized hydrogel microspheres to encapsulate Cutibacterium acnes (C. acnes)-derived extracellular vesicles (CA-EVs), enabling long term sustained release. Our findings indicate that, CA-EVs loaded gelatin methacrylate hydrogel microspheres (CA-EVs@GHM) showed superior therapeutic effects in treating psoriasis compared to CA-EVs. CA-EVs@GHM exhibited a more significant regulation of pathological type 3 innate lymphoid cells (ILC3) and skin microbiota, providing a promising approach for microbiota-derived extracellular vesicle therapy in the treatment of skin inflammation.
Cutibacterium acnes is a commensal skin bacterium, regularly implicated in prosthetic joint infection, particularly of the shoulder. Diagnosis has been improved by progress in bacteriological ...techniques: longer culture time, liquid medium culture, MALDI-TOF mass spectrography, and universal 16S rRNA PCR, associated by some authors to sonication of ablated implants. C. acnes pathogenicity involves many virulence factors, notably including biofilm formation. C. acnes may lead to infection that is clinically evident or, frequently, relatively asymptomatic. C. acnes is an anaerobic Gram-positive bacterium, susceptible to many antibiotics that are regularly used in bone and joint infection: beta-lactams, quinolone, rifampicin and clindamycin. It shows increasing resistance to clindamycin and natural resistance to metronidazole. Treatment is medical and surgical, associating synovectomy or complete 1- or 2-step revision depending on time to treatment, and antibiotic therapy. Antibiotic therapy is typically for three months with an initial 2–6 weeks’ intravenous phase. Prognosis is generally favorable with well-conducted treatment. Late discovery of positive samples after apparently aseptic implant change is an at-risk situation, usually managed by antibiotic therapy, but with late initiation and hence increased risk of failure. Adverse secondary progression requires repeat revision under good conditions.
The role of C. acnes biofilm production in the pathogenesis of breast implants infections has not been deeply assessed. We analyze biofilm production (in terms of biomass and metabolic activity) ...between 40 Cutibacterium acnes strains isolated from breast implants and 32 from other sites. C. acnes strains isolated from breast implants showed higher metabolic activity than those isolated from other-locations and, especially, those from patients with capsular contracture .
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