Discussion
We described a case of severe acne with two chronic lesions at the site
of orthopedic surgery.
We treated the patient empirically for P. acnes due to the patient’s
negative culture and clinical presentation. Acne is one of the most
common skin conditions; about one out of every five dermatological
consultations is for acne treatment. Acne typically manifests during
adolescent hormonal shifts; nevertheless, it is also a very frequent
adult-onset disorder. Acne can last for years and has a severe
psychosocial impact, including low self-esteem, despair, and social
disengagement. P. acnes can infect the skin in a variety of ways. Apart
from acne, P. acnes may contribute to post-operative infections and
device failure (8). Due to the sluggish growth of P. acnes, it cannot be
discovered in regular laboratory evaluations, and even when P. acnes is
isolated from a clinical specimen, it is considered contamination of the
skin flora (9).
Due to the excellent outcome and concurrent elimination of acneiform
lesions, we assume that P. acnes was responsible for SSI in our patient.
Furthermore, orthopedic implants were not contaminated in our case
because both ulcers cleared spontaneously and the patient exhibited no
systemic symptoms of infection, as WBC count, ESR, and CRP were all
within normal limits. Implant-associated infections caused by P. acnes
have been documented in the setting of shoulder prosthetic joint,
cerebrovascular shunt, and cardiovascular device infections (10). The
primary mechanism by which P. acnes causes these opportunistic
infections is its ability to create biofilms. Exact diagnosis may need a
longer culture time of up to 14 days for implant biopsy specimens, as
well as sophisticated molecular techniques, such as broad-range 16S rRNA
gene PCR (8). P. acnes is susceptible to a broad spectrum of
antibiotics, including beta-lactams, quinolones, clindamycin, and
rifampin, although clindamycin resistance is growing (10). The most
effective treatment for p. acnes infection of an implanted device is a
combination of surgical debridement and a prolonged antibiotic course.
However, multiple studies have established that device removal is the
best treatment approach, particularly for neurosurgical shunt infections
(11). Among the drugs discussed previously, rifampicin is the best
option due to its high penetration into the biofilm (12). Piper et al.
demonstrated that delayed post-implantation infection caused by P. acnes
typically occurs between three and twenty-four months after
implantation. Our patient developed SSI approximately three months
following surgery. Additionally, the majority of P. acnes-associated
opportunistic infections have been recorded in male patients, implying
that sex is a risk factor (13). However, earlier research indicates that
surface sterilizing before surgery does not eliminate the bacterium,
which is found deep within the sebaceous glands.