Propionibacterium acnesInfections in Shoulder Surgery

Perioperative shoulder infections involving Propionibacterium acnes can be difficult to identify in a patient who presents with little more than pain and stiffness in the postoperative period. Although indolent in its growth and presentation, infection of the shoulder with P acnes can have devastating effects, including failure of the surgical intervention. This article reviews the importance of a comprehensive physical, radiologic, and laboratory evaluation, and discusses appropriate preventive and treatment strategies for P acnes infections of the shoulder.

References

1. Patel A., Calfee R.P., Plante M., et al: [object Object]. J Shoulder Elbow Surg 2009; 18: pp. 897-902
2. Murray M.R., Saltzman M.D., Gryzlo S.M., et al: Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery. J Shoulder Elbow Surg 2011; 20: pp. 928-933
3. Piper K.E., Jacobson M.J., Cofield R.H., et al: Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol 2009; 47: pp. 1878-1884
4. Ryan M.J., Kavanaugh R., Wall P.G., et al: Bacterial joint infections in England and Wales: analysis of bacterial isolates over four years. Br J Rheumatol 1997; 36: pp. 370-373
5. Morgan D.S., Fisher D., Merianos A., et al: An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 1996; 117: pp. 423-428
6. Gupta M.N., Sturrock R.D., and Field M.: Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis. Ann Rheum Dis 2003; 62: pp. 327-331
7. Zimmerli W., Trampuz A., and Ochsner P.E.: Prosthetic-joint infections. N Engl J Med 2004; 351: pp. 1645-1654
8. Levy P.Y., Fenollar F., Stein A., et al: [object Object]. Clin Infect Dis 2008; 46: pp. 1884-1886
9. Athwal G.S., Sperling J.W., Rispoldi D.M., et al: Deep infection after rotator cuff repair. J Shoulder Elbow Surg 2007; 16: pp. 306-311
10. Levy O., Iyer S., Atoun E., et al: [object Object]. J Shoulder Elbow Surg 2013; 22: pp. 505-511
11. Pottinger P., Butler-Wu S., Neradilek M.B., et al: Prognostic factors for bacterial cultures positive for . J Bone Joint Surg Am 2012; 94: pp. 2075-2083
12. Saltzman M.D., Marecek G.S., Edwards S.L., et al: Infection after shoulder surgery. J Am Acad Orthop Surg 2011; 19: pp. 208-218
13. Millett P.J., Yen Y.M., Price C.S., et al: [object Object]. Clin Orthop Relat Res 2011; 469: pp. 2824-2830
14. Saltzman M.D., Nuber G.W., Gryzlo S.M., et al: Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am 2009; 91: pp. 1949-1953
15. Bosco J.A., Slover J.D., and Haas J.P.: Perioperative strategies for decreasing infection: a comprehensive evidence-based approach. Instr Course Lect 2010; 59: pp. 619-628
16. Schindler O.S., Spencer R.F., and Smith M.D.: Should we use a separate knife for the skin? J Bone Joint Surg Br 2006; 88: pp. 382-385
17. Zeller V., Ghorbani A., Strady C., et al: [object Object]. J Infect 2007; 55: pp. 119-124
18. Brems J.J.: Complications of shoulder arthroplasty: Infections, instability, and loosening. Instr Course Lect 2002; 51: pp. 29-39
19. Lutz M.F., Berthelot P., Fresard A., et al: Arthroplastic and osteosynthetic infections due to . Eur J Clin Microbiol Infect Dis 2005; 24: pp. 739-744
20. Niskanen R.O., Korkala O., and Pammo H.: Serum C-reactive protein levels after total hip and knee arthroplasty. J Bone Joint Surg Br 1996; 78: pp. 431-433
21. Dodson C.C., Craig E.V., Cordasco F.A., et al: [object Object]. J Shoulder Elbow Surg 2010; 19: pp. 303-307
22. Foruria A.M., Fox T.J., Sperling J.W., et al: Clinical meaning of unexpected positive cultures (UPC) in revision shoulder arthroplasty. J Shoulder Elbow Surg 2013; 22: pp. 620-627
23. Grosso M.J., Sabesan V.J., Ho J.C., et al: Reinfection rates after 1-stage revision shoulder arthroplasty for patients with unexpected positive intraoperative cultures. J Shoulder Elbow Surg 2012; 21: pp. 754-758
24. Shannon S.K., Mandrekar J., Gustafson D.R., et al: Anaerobic thioglycolate broth culture for recovery of . J Clin Microbiol 2013; 51: pp. 731-732
25. Butler-Wu S.M., Burns E.M., Pottinger P.S., et al: Optimization of periprosthetic culture for diagnosis of . J Clin Microbiol 2011; 49: pp. 2490-2495
26. Nord C.E., and Oprica C.: Antibiotic resistance in . Anaerobe 2006; 12: pp. 207-210
27. Eady E.A., Gloor M., and Leyden J.J.: [object Object]. Dermatology 2003; 206: pp. 54-56
28. Cooper A.J.: Systematic review of . Med J Aust 1998; 169: pp. 259-261
29. Ramage G., Tunney M.M., Patrick S., et al: Formation of . Biomaterials 2003; 24: pp. 3221-3227