The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is\r\nalso responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures\r\nincrease the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as\r\nprosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management\r\nof severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device).\r\nIntravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives,\r\nand amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic\r\nmaterial improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P.\r\nacnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby\r\nreduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will\r\nlikely continue to increase as new associations and pathogenic mechanisms are discovered.
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