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.