Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty

Updegrove, Gary F.; Armstrong, April; Kim, Hyun Min

doi:10.1016/j.jse.2014.10.005

Cited by 48 publications

(34 citation statements)

References 50 publications

(85 reference statements)

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“…The low sensitivity of our assay may also reflect the low virulence of P. acnes . Indeed this organism is often isolated in cases of fortuitous intraoperative cultures ( 7 , 31 – 34 ), and there are instances of clinically silent P. acnes PJIs defined bacteriologically and amenable to limited therapy ( 33 ). The correlation between serologically silent P. acnes and PJI diagnosed by fortuitous intraoperative culture should be explored.…”

Section: Discussionmentioning

confidence: 99%

Multiplex Antibody Detection for Noninvasive Genus-Level Diagnosis of Prosthetic Joint Infection

et al. 2016

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We developed and evaluated a multiplex antibody detection-based immunoassay for the diagnosis of prosthetic joint infections (PJIs). Sixteen protein antigens from three Staphylococcus species (Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus lugdunensis) (8 antigens), Streptococcus agalactiae (4 antigens), and Propionibacterium acnes (4 antigens) were selected by comparative immunoproteomics using serum samples from PJI cases versus controls. A bead-based multiplex immunoassay that measured serum IgG against purified, recombinant forms of each of the 16 antigens was developed. We conducted a prospective study to evaluate the performance of the assay. A PJI was defined by the presence of a sinus tract and/or positive intraoperative sample cultures (at least one sample yielding a virulent organism or at least two samples yielding the same organism). A total of 455 consecutive patients undergoing revision or resection arthroplasty (hip, 66.3%; knee, 29.7%; shoulder, 4%) at two French reference centers for the management of PJI were included: 176 patients (38.7%) were infected and 279 (61.3%) were not. About 60% of the infections involved at least one of the species targeted by the assay. The sensitivity/specificity values were 72.3%/80.7% for targeted staphylococci, 75%/92.6% for S. agalactiae, and 38.5%/84.8% for P. acnes. The assay was more sensitive for infections occurring >3 months after arthroplasty and for patients with an elevated C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). However, it detected 64.3% and 58.3% of targeted staphylococcal infections associated with normal CRP and ESR values, respectively. This new multiplex immunoassay approach is a novel noninvasive tool to evaluate patients suspected of having PJIs and provides information complementary to that from inflammatory marker values.

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Section: Discussionmentioning

confidence: 99%

Multiplex Antibody Detection for Noninvasive Genus-Level Diagnosis of Prosthetic Joint Infection

et al. 2016

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“…1 2 3) Particularly, end-stage postinfectious glenohumeral arthritis can lead to significant pain and disability. 4) While there are a number of studies focusing on arthroplasty options for the sequelae of septic arthritis in the lower extremity 5 6 7 8 9 10 11) and glenohumeral periprosthetic joint infection, 12 13 14 15 16 17 18) results of shoulder arthroplasty for postinfectious glenohumeral arthrosis have been less commonly reported.…”

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confidence: 99%

Outcomes of Shoulder Arthroplasty Performed for Postinfectious Arthritis

et al. 2018

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BackgroundThe purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis.MethodsThis is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations.ResultsThe 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m2. These patients underwent 14 reverse shoulder arthroplasties (RSAs; 11 after antibiotic spacer placement), one anatomic total shoulder arthroplasty after antibiotic spacer placement, and two hemiarthroplasties (both after antibiotic spacer placement). Two patients underwent reoperation (dislocated RSAs). There were four complications (23.5%): two RSA dislocations, one acromial stress fracture, and one atraumatic rotator cuff tear after hemiarthroplasty. There were no cases of postoperative wound complications or infection. At an average of 4.1 ± 1.8 years of follow-up for all 17 of 17 cases, the average visual analogue scale pain score was 4.6 ± 2.3, average Single Assessment Numeric Evaluation Score was 59.3 ± 23.7, average American Shoulder and Elbow Surgeons Score was 57.6 ± 15.5, and average Simple Shoulder Test was 6.9 ± 2.6 based on “yes” responses.ConclusionsShoulder arthroplasty after septic arthritis had inconsistent functional outcomes and high complication rates but no reinfection.

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“…The last limitation, already reported above, is that an increased number of bacteria is not synonymous with infection because of other variables (such as the type of skin preparation) could affect the rate of infection. Although, there are no clear data linking bacterial volume on the skin to infection rates, recent studies have suggested that shoulder postoperative infections are often caused by skin bacteria, [23][24][25][26] including P. Acnes. [27][28][29][30] The single case of postoperative infection in our cohort of patients was reported in a patient with an extremely high preoperative load of P. Acnes on the site of the deltopectoral approach.…”

Section: Discussionmentioning

confidence: 99%

Effect of surgical delay on bacterial colonization in proximal humeral fractures

Blonna

Prun

Bellato

et al. 2015

Journal Orthopaedic Research

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Postoperative infection is a severe complication after proximal humeral fracture surgical treatment. The aim of this study was to determine if the surgical delay could modify the number and type of bacteria on the surgical site. A two stages study was set up. In the first stage the effect of delay was simulated in 20 patients affected by proximal humeral fracture treated conservatively. In a second stage, the effect of delay was measured in 20 patients that underwent surgery. In stage 1, three skin culture swabs were taken in correspondence of the deltopectoral approach, the day of the fracture (day 0), the day after (day 1), and five days after fracture (day 5). In stage 2, skin swab cultures were taken the day of trauma and immediately before surgery and cultured on various media suitable for aerobic and anaerobic bacteria. The number of bacteria increased over the course of the study, from day 0 to day 5, both considering the total number of colony-forming units and individual species of pathogen bacteria. The second stage of the study confirmed these data. An increasing number of bacteria was observed in patients that underwent surgery later than 2 days from trauma. The delay of surgery increased bacterial colonization of the skin in the deltopectoral approach area including common pathogenic bacteria such as Staphylococcus aureus, coagulase-negative staphylococci and Propionibacterium acnes. This might justify the correlation between delay to surgery and risk of infection.

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Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty

Cited by 48 publications

References 50 publications

Multiplex Antibody Detection for Noninvasive Genus-Level Diagnosis of Prosthetic Joint Infection

Multiplex Antibody Detection for Noninvasive Genus-Level Diagnosis of Prosthetic Joint Infection

Outcomes of Shoulder Arthroplasty Performed for Postinfectious Arthritis

Effect of surgical delay on bacterial colonization in proximal humeral fractures

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