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C. acnes Spine Implant Retention — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionC. acnes Spine Implant RetentionSCE Infectious Diseases

A 55-year-old man with a titanium spinal fusion develops low-grade infection 18 months post-surgery. Tissue cultures grow Cutibacterium acnes. The metalwork is stable and well-positioned. What is the approach?

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Correct answer: B — Prolonged antibiotic therapy WITH metalwork retention may be attempted — C. acnes spinal implant infections can sometimes be managed with prolonged oral Amoxicillin (6–12 months) if the metalwork is stable and the infection is low-grade

E. acnes spinal implant infection management is nuanced. If metalwork is well-positioned, stable, and achieving its biomechanical purpose, prolonged antibiotic therapy with implant retention can be attempted. C. acnes is almost always Penicillin-susceptible — oral Amoxicillin 500 mg TDS for 6–12 months is the standard oral regimen. Rifampicin may be added for anti-biofilm synergy. If clinical/biochemical response is poor, or if metalwork loosening occurs, surgical revision with hardware exchange may be needed. Close CRP and clinical monitoring guides duration.

Reference: BSAC 2023 – Spinal infections; NICE NG157 2024