Propionibacterium acnes infection in patients with CSF shunts

BACKGROUND AND METHODS: Propionibacterium acnes is a common inhabitant of human skin rarely associated with clinical disease. However it has been recognized as a cause of shunt and postneurosurgical infections. From January 1992 to June 1995, 5,947 cerebrospinal fluid (CSF) samples were cultured in our laboratory. We carried out a clinical-epidemiological study in patients where P. acnes was isolated from CSF. RESULTS: P, acnes was isolated from 11 CSF samples which corresponded to 7 episodes of shunt infection in 6 patients. Five were men; the mean age was 28.5 years. The mean time of onset of infection after the last shunt manipulation was 104 weeks. All of them presented symptomatology associated with infection. All episodes but one, where P. acnes was considered to be a contaminant, were treated with systemic and intraventricular antibiotic therapy and complete shunt removal. Four patients made an uneventful recovery and two patients died due to causes not directly related with the infection. CONCLUSIONS: P. acnes is frequently isolated in patients with shunt infections. Its isolation must be seriously considered not viewed as a contaminant without an exhaustive investigation.