Surgical Infections of the sternum

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pellicle

Professional Dingbat
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Nov 4, 2012
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Queensland, OzTrayLeeYa
As some of you may know I have a keen interest in this area. I have recently conjectured that mobile sternum could actually be a symptom of an infection which goes largely diagnosed. For those who have had this problem post surgery (where the sternum fails to join) I found this interesting reading.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317161/

particularly the following points
Cutibacterium acnes (formerly Propionibacterium acnes) is recognized as a pathogen in foreign-body infections (arthroplasty or spinal instrumentation). To date, the direct impact of C. acnes on bone cells has never been explored.

Bone is a mineralized tissue constantly remodeled under the simultaneous coordinated action of three cell types: bone matrix-resorbing osteoclasts, bone matrix-forming osteoblasts, and osteocytes embedded in the mineralized bone matrix[SUP]1[/SUP]. This physiological process is tightly regulated and crucial to maintain a constant bone mass in adults. However, this balance can be impaired to favor resorption in pathological conditions, such as osteoporosis or bone and joint infection (BJI)

The pathogenicity of Cutibacterium acnes has long been restricted to skin conditions[SUP]2[/SUP]. However, C. acnes is increasingly recognized as a pathogen, mainly in foreign-body infections, such as arthroplasty or spinal instrumentation-associated infections[SUP]3[/SUP][SUP],4[/SUP]. The role of C. acnes in foreign-body infections is probably underestimated because, as an anaerobe, it needs an adapted bacterial transport system and usually a prolonged incubation time of up to 14 days for growth

The absence of a gold standard for the diagnosis and accurate criteria to define foreign-body infection may explain why C. acnes torpid infections are sometimes misclassified as aseptic loosening or mechanical failure[SUP]9[/SUP].

Therefore, the association between implant surgery and C. acnes infection is not always obvious
So I'd suggest that if you happen to be wondering about your sternum problems, perhaps this is a recent understanding which may be applicable.

I will be meeting with my infection specialist in some weeks and you can be sure this will be on the table.
 

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