Early Versus Late Culture Growth of Propionibacterium acnes in Revision Shoulder Arthroplasty

Frangiamore, Salvatore J.; Saleh, Anas; Grosso, Matthew J.; Alolabi, Bashar; Bauer, Thomas W.; Iannotti, Joseph P.; Ricchetti, Eric T.

doi:10.2106/jbjs.n.00881

Cited by 109 publications

(62 citation statements)

References 24 publications

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“…Our results may not be transposable to PJI infections other than hip and knee. As the proportion of skin commensals like C. acnes is higher in shoulder PJI, further studies are needed to describe the time of growth of bacteria found in other PJI locations [19,21].…”

Section: Discussionmentioning

confidence: 99%

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Deroche

Bémer

Valentin

et al. 2019

JCM

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Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

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Section: Discussionmentioning

confidence: 99%

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Deroche

Bémer

Valentin

et al. 2019

JCM

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“…Furthermore, the study showed that a prolonged cultivation time of Ͼ10 days did not improve sensitivity. Therefore, Frangiamore et al (3) recommended that a routine cultivation time of 10 days is optimal to ensure accurate diagnosis of P. acnes infections. Our data support this recommendation.…”

Section: Fig 2 Proportions Of First (A) or Second (Confirmation) (B) mentioning

confidence: 99%

“…However, it may also cause bone and joint infections, including implant-associated infections. P. acnes has been recognized as an emerging cause of shoulder infections (2,3) and is among the most common pathogens isolated in shoulder periprosthetic joint infections (PJI) (4,5). P. acnes has also been implicated in other biofilm-related infections (6)(7)(8), such as cardiovascular implantassociated infections (9), spinal osteomyelitis (10,11), and endophthalmitis (12,13).…”

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confidence: 99%

Optimal Length of Cultivation Time for Isolation of Propionibacterium acnes in Suspected Bone and Joint Infections Is More than 7 Days

et al. 2016

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Diagnosis of Propionibacterium acnes bone and joint infection is challenging due to the long cultivation time of up to 14 days. We retrospectively studied whether reducing the cultivation time to 7 days allows accurate diagnosis without losing sensitivity. We identified patients with at least one positive P. acnes sample between 2005 and 2015 and grouped them into "infection" and "no infection." An infection was defined when at least two samples from the same case were positive. Clinical and microbiological data, including time to positivity for different cultivation methods, were recorded. We found 70 cases of proven P. acnes infection with a significant faster median time to positivity of 6 days (range, 2 to 11 days) compared to 9 days in 47 cases with P. acnes identified as a contamination (P < 0.0001). In 15 of 70 (21.4%) patients with an infection, tissue samples were positive after day 7 and in 6 patients (8.6%) after day 10 when a blind subculture of the thioglycolate broth was performed. The highest sensitivity was detected for thioglycolate broth (66.3%) and the best positive predictive values for anaerobic agar plates (96.5%). A prolonged transportation time from the operating theater to the microbiological laboratory did not influence time to positivity of P. acnes growth. By reducing the cultivation time to 7 days, false-negative diagnoses would increase by 21.4%; thus, we recommend that biopsy specimens from bone and joint infections be cultivated to detect P. acnes for 10 days with a blind subculture at the end. P ropionibacterium acnes is a facultative anaerobic Gram-positive rod, abundant on the human skin, and mainly associated with the sebaceous glands of the shoulder and axilla (1). It is most commonly associated with the chronic skin disease acne vulgaris. However, it may also cause bone and joint infections, including implant-associated infections. P. acnes has been recognized as an emerging cause of shoulder infections (2, 3) and is among the most common pathogens isolated in shoulder periprosthetic joint infections (PJI) (4, 5). P. acnes has also been implicated in other biofilm-related infections (6-8), such as cardiovascular implantassociated infections (9), spinal osteomyelitis (10, 11), and endophthalmitis (12, 13).Diagnosis of P. acnes bone and joint infections is challenging since pain is often the only symptom (14, 15). For a long time, P. acnes was underdiagnosed in bone and joint infections due to the short cultivation time routinely used in diagnostic laboratories. In general, biofilm-forming bacteria are known to replicate at a slow rate due to low metabolism (16). Since recent studies recommended a prolonged cultivation time of up to 14 days for bone and joint infections (17, 18), the diagnosis of P. acnes infections has become more frequently documented (19). In view of the high costs of a long incubation period, a recent study suggested that 7 days of incubation should be sufficient for accurately diagnosing orthopedic implant-associated infections (20). In this study, 96.6% ...

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“…Propionibacterium acnes is a gram‐positive bacillus that resides in sebum glands. 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%

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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Early Versus Late Culture Growth of Propionibacterium acnes in Revision Shoulder Arthroplasty

Abstract: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 109 publications

References 24 publications

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Optimal Length of Cultivation Time for Isolation of Propionibacterium acnes in Suspected Bone and Joint Infections Is More than 7 Days

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

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