Clinical meaning of unexpected positive cultures (UPC) in revision shoulder arthroplasty

Cyanoacrylate Microbial Sealant May Reduce the Prevalence of Positive Cultures in Revision Shoulder Arthroplasty

“…Our positive culture rate of 18% in Group SP and overall rate of 15% were comparable to the unexpected positive culture rates ranging from 11% to 56% [8,9,12,16,19] (Table 4) reported in the literature. We found that the prevalence of positive cultures was more than double in Group SP compared with those receiving the sealant with more than a 2.6 times higher risk of positive cultures in those without the sealant, although without reaching statistical significance as a result of the study being underpowered.…”

“…Reported values range from 11% to 56% [8,9,12,16,19]. For the control (SP) group, we assumed a 25% rate with a SD of 15%.…”

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

“…P ropionibacterium species are often grown on culture of specimens obtained at the time of orthopaedic revision surgery. The pathogenicity of this organism has been demonstrated for patients who have undergone shoulder implant surgery [1][2][3][4][5][6][7][8][9][10][11][12][13][14] , hip or knee arthroplasty [15][16][17][18][19][20][21][22] , or spine surgery [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] . While many cases of Propionibacterium infections are attributed to Propionibacterium acnes, other species of Propionibacterium have been recovered from revision surgical sites 38 .…”

“…It is commonly assumed that the patient's epidermal skin surface is the source of the Propionibacterium grown on culture of specimens from infected orthopaedic implant sites. Unfortunately, presurgical skin surface preparations do not completely eliminate Propionibacterium [39][40][41][42] , perhaps because the organism is sheltered in dermal sebaceous glands, each of which may harbor as many as 10 5 Propionibacterium organisms per follicle 43 . Surgical incisions transect the sebaceous glands, after which these organisms may Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work.…”

Management of complications after revision shoulder arthroplasty

“…Grosso et al treated patients with unexpected positive intraoperative cultures with a one-stage revision and no postoperative antibiotics and found low reinfection rates (5.9 %) [83]. Another study supported ignoring or monitoring unexpected intraoperative positive cultures of low virulence and negative preoperative workup in healthy patients [84]. Recently, Pottinger et al found preoperative and intraoperative risk factors that correlate with positive cultures during revision surgery.…”