Cutibacterium acnes Gram Positive Bacteria Causing Infection

by Felix MONTERO-JULIAN PhD — February 25, 2020

WHAT IS CUTIBACTERIUM ACNES

Cutibacterium acnes: a complex Gram positive bacteria

Cutibacterium acnes (C. acnes) is a Gram positive bacteria that prefers anaerobic (without air) growth conditions1. Cutibacterium acnes can be found on the skin of virtually every human, and it is one of the bacteria that can cause acne. Acne is one of the most common skin diseases, affecting more than 45 million individuals in the United States. It is estimated that nearly 20 percent of all visits to dermatologists are related to the treatment of acne. Cutibacterium acnes is generally considered non-pathogenic, meaning it doesn’t cause disease. However, there is a growing body of evidence that point out its involvement in several types of postoperative infections and other chronic conditions such as endocarditis² and eye infections³, as well as can affect the spine⁴. In addition, C. acnes has the ability to persist on body implants and surgical devices, causing a wide-range of post-operative infectious conditions⁵.

This article gives an overview of:
● The Cutibacterium acnes

● How Cutibacterium acnes is transmitted

● How Cutibacterium acnes can be detected, prevented and controlled

● The risks of Cutibacterium acnes for consumers

● Treating Cutibacterium acnes

● Industries affected by Cutibacterium acnes

● bioMérieux’s products and solutions for detecting and preventing Cutibacterium acnes

PREVENTION, DETECTION AND TREATMENT

How is the Cutibacterium acnes transmitted?

Cutibacterium acnes exists on the skin of nearly every person. This means that it is easily transmitted through skin contact.

How Cutibacterium acnes can be detected prevented and controlled?

C. acnes can act as an opportunistic pathogen causing invasive and chronic implant infections. For its successful microbiological diagnosis, multiple conventional tissue cultures, sonication (sound energy) of the removed implant or its mobile parts, and/or synovial fluid aspiration (removing fluids) is recommended⁶.

Cutibacterium acnes is susceptible to a wide range of chemicals, making it relevant when testing antimicrobial efficacy (chemical preservation) of substances. For example, Benzoyl peroxide kills Cutibacterium acnes. This medication helps remove excess oils from the skin, as well as dead skin cells that clog pores, which is often a treatment for acne.

Detecting Cutibacterium acnes is also a challenge and requires validated testing methods that take into consideration its unique characteristics. The FDA advised drug manufacturers to establish suitable methods to prevent contamination, such as:

● Maintaining the adequate quality of incoming materials, sanitary design, cleaning of equipment, production and storage time limitations, and monitoring of environmental conditions.
● Use scientifically sound and appropriate acceptance criteria and testing procedures to assure that drug or implant product components (including pharmaceutical water) and finished drug or implant products conform to appropriate quality standards.
● Provide appropriate product specifications (tests, methods, and acceptance criteria) in applications submitted to regulatory officials for new drug applications.
● When appropriate, additional laboratory tests may be needed to determine whether products are suitable for release.
● Investigate any failure to meet specifications, including other batches of the same drug product and other drug products that may have been associated with the specific failure or discrepancy and implement appropriate corrective and follow-up actions to prevent recurrence⁷.

How can the presence of Cutibacterium acnes be detected in the pharmaceutical products?

The optimal temperature for growth of Cutibacterium acnes is 37°C. To increase its detection, prolonged aerobic and anaerobic cultures for 14 days and use enrichment broth that supports the growth of microorganisms⁸. Samples can be also analyzed using the blood culture device BacT/ALERT 3D⁹ from bioMerieux.

What are the risks of Cutibacterium acnes to the consumer?

The worldwide prevalence of antibiotic-resistant C. acnes is increasing, with rates varying in different parts of the world. The reason for the difference in the antibiotic resistance patterns of C. acnes among different countries is not clear, although it may be attributed to different antibiotic prescribing habits, varying use of topical agents (retinoids, benzoyl peroxide, or other antibiotics), differing methods of bacterial sampling, or even different C. acnes populations.

Currently, C. acnes is also considered an opportunistic pathogen in infections linked to surgical procedures, foreign bodies, septicemia, and in implant-associated infections.

What is the treatment for Cutibacterium acnes contamination?
The optimal treatment of C. acnes infections consists of systemic antibiotics and removal of foreign bodies, as well as consequence corrections¹⁰. Antibiotics used to treat anaerobic infections usually suffice for other types C. acnes related infections as well. These include¹¹:

● Penicillin

● Carbapenems

● Clindamycin

● Vancomycin

● Teicoplanin

KEY FIGURES

● Cutibacterium acnes are part of the normal skin.

● It is estimated that nearly 20 percent of all visits to dermatologists are related to the treatment of acne.

● C. acnes can tolerate exposure to oxygen for several hours and is capable in vitro to survive under anaerobic conditions for up to 8 months¹².

● C. acnes is the slowest growing of usual test organisms.

● C. acnes can be killed with ultraviolet light.

● C. acnes is an immune stimulant.

What common industries are affected by Cutibacterium acnes? 

Cutibacterium acnes can be relevant for:
● Drug manufacturers of non-sterile & water-based drug products

● Medical device systems

● Cell therapy manufacturers

● Blood banks

1 Leheste, Joerg R., Ruvolo, Kathryn E., Chrostowski, Joanna E., Rivera, Kristin, Husko, Christopher, Miceli, Alyssa.,Selig, Martin K, Brüggemann, Holger and Torres, German (2017) C. acnes-Driven Disease Pathology: Current Knowledge and Future Directions. Frontiers in Cellular and Infection Microbiology March, 7 : 81, 1- 9
2 Lazar JM, Schulman DS. Propionibacterium acnes prosthetic valve endocarditis: a case of severe aortic insufficiency. Clinical Cardiology. 1992;15:299–300
3 Underdahl JP, Florakis GJ, Braunstein RE, Johnson DA, Cheung P, Briggs J, Meisler DM. Propionibacterium acnes as a cause of visually significant corneal ulcers. Cornea. 2000;19:451–454
4 Thompson TP, Albright AL. Propionibacterium acnes infections of cerebrospinal fluid shunts. Childs Nervous System. 1998;14:378–380 5 Acherman, Y., Goldstein, E.J.C., Coenye, T., Shirtliff, M.E. (2014) Propionibacterium acnes: from commensal to opportunistic biogfilm-associated implant pathogen Clin. Microbio. Rev, Jul; 27(3): 419-440; Portillo, María Eugenia, Corvec, Stéphane, Borens, Olivier and Trampu, Andrej, (2013) Propionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections n BioMed Research International Volume 2013, page 1-10 Article ID 804391, 10 pages
5 Acherman, Y., Goldstein, E.J.C., Coenye, T., Shirtliff, M.E. (2014) Propionibacterium acnes: from commensal to opportunistic biogfilm-associated implant pathogen Clin. Microbio. Rev, Jul; 27(3): 419-440; Portillo, María Eugenia, Corvec, Stéphane, Borens, Olivier and Trampu, Andrej, (2013) Propionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections n BioMed Research International Volume 2013, page 1-10 Article ID 804391, 10 pages
6 Achermann, Yvonne, Goldstein, Ellie J. C., Coenye, Tom, Shirtliffa, Mark E.,
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Pathogen (2014) Clinical Microbiology Reviews, July Volume 27 Number 3: 419-440
7https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-drug-manufacturersburkholderia-
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8 Viraraghavan R, Jantausch B, Campos J. Late-onset central nervous system shunt infections with Propionibacterium acnes: diagnosis and management. Clinical Pediatrics. 2004;43(4):393–397, Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clinical Infectious Diseases. 2008;47(11):1403–1409, Butler-Wu SM, Burns EM, Pottinger PS, et al. Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. Journal of Clinical Microbiology. 2011;49(7):2490–2495
9 Arlt, Nicole , Rothe, Remo , Sielaff, Susann , Juretzek, Thomas , Peltroch, Heidrun (2018) Sterility release testing of peripheral blood stem cells for transplantation: impact of culture bottles and incubation temperature, December Volume58, Issue12 10 Holmberg A, Lood R, Morgelin M, et al. Biofilm formation by Propionibacterium acnes is a characteristic of invasive isolates. Clin Microbiol Infect. 2009;15(8):787–9
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