Cutibacterium acnes (formerly Propionibacterium acnes) is a significant pathogen in periprosthetic joint infections (PJIs) in total shoulder arthroplasty. Poor outcomes seen in PJIs are due to the established C. acnes bacterial biofilms. The prolonged nature of C. acnes infections makes them difficult to treat with antibiotics. The goal of this study was to determine the relative efficacy of vancomycin compared with penicillin and doxycycline against planktonic and mature biofilms. Clinical isolates from PJI patients as well as a laboratory strain of C. acnes were tested. Planktonic minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) were obtained using modified clinical laboratory standard index assays. Biofilm MICs and MBCs were also obtained. The MIC was determined for both using the PrestoBlue viability stain. The MBC was determined using differential reinforced clostridial medium agar plates for colony-forming unit analysis. Using the PrestoBlue viability reagent, the planktonic MIC values for vancomycin were significantly higher than doxycycline. Across 10 strains of C. acnes, all three antibiotics had decreased efficacy when comparing planktonic and biofilm cultures. Although effective antibiotic doses ranged from 1 to 1,000 μg/mL, only doxycycline achieved inhibitory and bactericidal concentrations in all tested strains. Penicillin failed to achieve the minimum biofilm inhibitory concentration (MBIC) in 60% of tested strains, whereas vancomycin failed in 80% of tested strains. Penicillin, doxycycline, and vancomycin have similar abilities in inhibiting C. acnes growth planktonically. The MBIC for doxycycline was within the clinical dosing range, suggesting C. acnes biofilm offers minimal tolerance to these antibiotics. The MBIC for penicillin was within clinical dosing ranges in only 60% of trials, suggesting the relative tolerance of C. acnes to penicillin. The minimum biofilm bactericidal concentration (MBBC) of doxycycline showed efficacy in 90% of trials, whereas penicillin and vancomycin achieved MBBC in 15% of samples.
Author Information
Budge, Matthew, D.
NW Permanente, Salem, OR, US
Koch, John, A.
Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, Pittsburgh, PA, US
Mandell, Jonathan, B.
Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, Pittsburgh, PA, US
Cappellini, Alex, J.
Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, Pittsburgh, PA, US
Orr, Sara
Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, Pittsburgh, PA, US
Patel, Samik
Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, Pittsburgh, PA, US
Ma, Dongzhu
Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, Pittsburgh, PA, US
Nourie, Olivia
NW Permanente, Salem, OR, US
Brothers, Kimberly, M.
Arthritis and Arthroplasty Design Group, Dept. of Orthopaedic Surgery, Pittsburgh, PA, US
Urish, Kenneth, L.
Arthritis and Arthroplasty Design Group, The Bone and Joint Center, MageeWomens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USDept. of Orthopaedic Surgery, Dept. of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, US
Domestic orders are delivered via United Parcel Service (UPS) or United States Postal Service (USPS). Transit
times average 3 to 5 business days. Please be aware that UPS will not deliver packages to Post Office Boxes.
International orders are delivered via courier post services which can be either a postal service, courier
service, or a combination of both. Standard Service is untraceable. Please allow 4-7 weeks for delivery.
Please be aware that carriers will not deliver packages to Post Office Boxes. Because of the variability of
customs processes and procedures in different countries, ASTM International cannot guarantee transit times to
international destinations. Customs duty and taxes are the responsibility of the consignee.
Shipping & Handling charges follow the rate schedule, below:
Order Total
Shipping & Handling Fee (US Domestic)
Up to $50.00
$18.72
$50.01 to $100.00
$20.80
$100.01 to $150.00
$29.52
$150.01 to $250.00
$39.09
$250.01 to $500.00
$56.25
$500.01 to $750.00
$76.42
$750.01 to $1000.00
$93.15
$1000.01 to $1500.00
$121.27
$1500.01 to $2500.00
$158.38
$2500.01 to $4999.00
$209.04
$5000.00 to higher
FREE
Order Total
Shipping & Handling Fee (International)
Up to $50.00
$68.72
$50.01 to $100.00
$70.80
$100.01 to $150.00
$79.52
$150.01 to $250.00
$89.09
$250.01 to $500.00
$106.25
$500.01 to $750.00
$126.42
$750.01 to $1000.00
$143.15
$1000.01 to $1500.00
$171.27
$1500.01 to $2500.00
$208.38
$2500.01 to $4999.00
$259.04
$5000.00 to higher
FREE
Shipping and Handling charges are approximate. Additional charges may be incurred if your order requires multiple shipments. This does not apply to complete sets and sections.
