Contamination of the Surgical Field with Propionibacterium acnes in Primary Shoulder Arthroplasty

Falconer, Travis M.; Baba, Mohammed; Kruse, Lisa M.; Dorrestijn, Oscar; Donaldson, Matthew J; Smith, Margaret M.; Figtree, Melanie; Hudson, Bernard; Cass, Benjamin; Young, Allan

doi:10.2106/jbjs.15.01133

Cited by 90 publications

(59 citation statements)

References 18 publications

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“…It is the most common bacterium found in the deep tissues at the time of revision shoulder arthroplasty performed for pain, stiffness, and component loosening (3). Because common skin preparations and antibiotics given around the time of surgery fail to completely eradicate the bacteria (5)(6)(7)(8)(9), particularly those under the skin surface, transection of the dermal structures can lead to inoculation of C. acnes (and related Cutibacterium species) into the deeper tissues and implants at the time of the original shoulder arthroplasty (10,11). Over time, these slow-growing bacteria are believed to be responsible for arthroplasty failure resulting in a need for a revision surgery.…”

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confidence: 99%

Cutibacterium acnes Isolates from Deep Tissue Specimens Retrieved during Revision Shoulder Arthroplasty: Similar Colony Morphology Does Not Indicate Clonality

2020

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Cutibacterium acnes is the most common bacterium associated with periprosthetic shoulder infections. Sequencing of C. acnes has been proposed as a potential rapid diagnostic tool and a method of determining subtypes associated with pathogenicity and antibiotic resistance patterns. When multiple deep samples from the same surgery are culture positive for the same species and the isolates show the same culture phenotype, it is typically assumed that these isolates are clonal. However, it is well-known that C. acnes is not clonal on the skin of most individuals. We hypothesized that the C. acnes bacteria recovered at the time of revision shoulder arthroplasty would often represent more than one subtype, and we tested this hypothesis in this work. For patients undergoing revision shoulder arthroplasty, multiple samples from the surgical field were taken. For those patients with multiple samples that were culture positive for C. acnes, isolates from each sample were subjected to full genome sequencing. Of 11 patients, 5 (45%) had different subtypes of C. acnes within the deep tissues even though the colony morphology was similar. One patient had four subtypes in the deep tissues, while four patients had two different subtypes. Up to four different subtypes of C. acnes were observed in the deep tissues of a single patient. Clonality of C. acnes isolates from deep specimens from a potential periprosthetic shoulder infection cannot be assumed. Sequence-based characterization of virulence and antibiotic resistance may require testing of multiple deep specimens.

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confidence: 99%

Cutibacterium acnes Isolates from Deep Tissue Specimens Retrieved during Revision Shoulder Arthroplasty: Similar Colony Morphology Does Not Indicate Clonality

2020

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“…A perceived weakness of this study design is the apparent lack of a control comparator, to determine the incidence of P. acnes in the subdermal without the use of the wound protector drape. Our justification for this is that several studies have already reported the incidence of P. acnes in the subdermal layer and given that our incidence of 23% (positive swabs of the subdermal layer) correlates with those published data, we consider this to be an acceptable comparator.…”

Section: Discussionmentioning

confidence: 74%

“…It is a common contaminant in shoulder surgery, and a potential pathogen in post‐operative shoulder infections . Recent studies indicate a high incidence of P. acnes in the subdermal layer, and it is postulated that the organism may be carried into the deeper tissues during surgery by instruments or by hand …”

Section: Discussionmentioning

confidence: 99%

“…Power analysis was determined based on demonstrating a 25% reduction in P. acnes positive cultures between the surface of the barrier drape and the subdermal layer at the end of the operation, based on the incidence described by Falconer et al . To demonstrate a difference with a power of 0.8 and P < 0.05, 42 patients were required.…”

Section: Methodsmentioning

confidence: 99%

“…A recent publication demonstrated the high prevalence of P. acnes in the subdermal layer around the shoulder. It postulated transmission of the bacteria from the subdermal layer to the deeper tissues was a causative factor in the development of P. acnes deep infections following shoulder surgery …”

Section: Introductionmentioning

confidence: 99%

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Minimizing Propionibacterium acnes contamination in shoulder arthroplasty: use of a wound protector

Smith¹,

Gotmaker

Hoy³

et al. 2018

ANZ Journal of Surgery

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Background: Propionibacterium acnes may be transmitted from the subdermal tissues to the deeper tissues during shoulder arthroplasty surgery, resulting in deep infection. The aim of this prospective, clinical study was to determine whether the use of a wound protector drape can lower the incidence of P. acnes in the wound during shoulder arthroplasty surgery. Methods: For a consecutive series of 47 patients undergoing shoulder arthroplasty, a wound protector drape was used during surgery, to isolate the subdermal layer from the surgeons' hands, retractors and other instruments. Microbiological swabs were taken both from the subdermal layer and the exposed drape to determine the incidence of P. acnes at both sites. Results: The overall incidence of P. acnes in the subdermal layer was 23%. A fivefold decrease in the incidence of P. acnes in the exposed superficial layer was demonstrated by use of the wound protector drape. Conclusion: Use of a wound protector drape to isolate the superficial tissue layer from the surgeons' gloves, instruments and retractors decreases the incidence of P. acnes in the surgical field. This may result in a decreased rate of transmission to the deeper tissues, and a decreased rate of P. acnes deep infection.

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Shoulder Arthroplasty and Infection

Charubhumi,

Jawa

2023

Shoulder Arthritis Across the Life Span

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Contamination of the Surgical Field with Propionibacterium acnes in Primary Shoulder Arthroplasty

Abstract: P. acnes is likely to be spread throughout the surgical field from the subdermal layer via soft-tissue handling by the surgeon and instruments. Strategies need to be utilized to minimize this contact and to reduce the chance of colonization.

Cited by 90 publications

References 18 publications

Cutibacterium acnes Isolates from Deep Tissue Specimens Retrieved during Revision Shoulder Arthroplasty: Similar Colony Morphology Does Not Indicate Clonality

Cutibacterium acnes Isolates from Deep Tissue Specimens Retrieved during Revision Shoulder Arthroplasty: Similar Colony Morphology Does Not Indicate Clonality

Minimizing Propionibacterium acnes contamination in shoulder arthroplasty: use of a wound protector

Shoulder Arthroplasty and Infection

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