Basic SciencePresence of Propionibacterium acnes in primary shoulder arthroscopy: results of aspiration and tissue cultures
Section snippets
Materials and methods
Sterile skin swabs, aspirated joint fluid, and tissue specimens were collected from June 2013 to September 2013 from 57 patients undergoing shoulder arthroscopy without any previous shoulder surgery. Demographic data, visual analog scale (VAS) for pain, and medical comorbidities were also collected. Our inclusion criterion was shoulder disease necessitating primary shoulder arthroscopy. Our exclusion criteria were previous shoulder surgery and antibiotic treatment within 4 weeks before surgery.
Results
This study included 57 patients. There were 32 men (56.1%) and 25 women (43.9%). The mean age of the patients was 51 years (range, 17-81 years). Eleven patients reported osteoarthritis of joints other than the shoulder, 3 were current smokers or had a history of smoking, 4 had type 2 diabetes mellitus, and 8 were obese. Fifty-six percent of subjects had not had a cortisone injection on the surgical shoulder before surgery, and 44% had either 1 or more cortisone injections on the operative
Discussion
Infection after shoulder surgery has a serious impact on patient outcome and costs associated with care. P. acnes infection may be insidious and manifest years after index surgery with resultant joint arthropathy or prosthesis infection.13 Our goal was to investigate the presence of P. acnes, specifically how often cultures would become positive, in a group of patients undergoing primary arthroscopic shoulder surgery. We found a high rate of positive cultures for P. acnes; 56% of subjects had
Conclusions
Of all individuals studied, 56% had at least 1 positive culture for P. acnes. P. acnes was identified in 21.8% of 371 culture specimens obtained, including skin swab, synovial fluid aspiration, and tissue biopsy in a cohort of subjects without previous surgery or arthritis of the glenohumeral joint. Despite skin preparation and preoperative antibiotics, patients undergoing shoulder arthroscopy are exposed to and inoculated with P. acnes, likely from contamination of the joint with residual
Disclaimer
The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
Acknowledgments
The authors thank Steve Delaronde for statistical analysis, Richie Fuld for help with IRB application and Greenwich Hospital microbiology laboratory for identifying bacterial presence on the samples.
References (24)
- et al.
Complications after arthroscopic rotator cuff repair
Arthroscopy
(2007) - et al.
Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge
J Shoulder Elbow Surg
(2010) - et al.
Infection after mini-open rotator cuff repair
J Shoulder Elbow Surg
(2002) - et al.
Management of early deep infection after rotator cuff repair surgery
J Shoulder Elbow Surg
(2005) - et al.
Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis?
J Shoulder Elbow Surg
(2013) - et al.
Propionibacterium acnes colonization of the human shoulder
J Shoulder Elbow Surg
(2009) - et al.
Infection after rotator cuff repair
J Shoudler Elbow Surg
(1999) - et al.
A 7-year retrospective review from 2005 to 2011 of Propionibacterium acnes shoulder infections in Ottawa, Ontario, Canada
Diagn Microbiol Infect Dis
(2013) - et al.
Propionibacterium acnes: an agent of prosthetic joint infection and colonization
J Infect
(2007) - et al.
Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group
J Clin Microbiol
(1998)
Outbreak of postoperative shoulder arthritis due to Propionibacterium acnes infection in nondebilitated patients
Infect Control Hosp Epidemiol
Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection
J Clin Microbiol
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The Greenwich Hospital Institutional Review Board approved this study: No. 2013006.