Low-grade infections in nonarthroplasty shoulder surgery

Khan, Umair; Torrance, Emma; Townsend, Robert; Davies, Steve; Mackenzie, Tanya Anne; Funk, Lennard

doi:10.1016/j.jse.2017.01.008

Cited by 23 publications

(24 citation statements)

References 57 publications

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“…Khan et al 40 reported on 35 patients that presented with a presumed low-grade shoulder erythema following shoulder arthroscopy. 40 Of these 35 patients, 21 had positive intraoperative cultures, with C. acnes accounting for 81% of infections. Horneff et al 41 retrospectively reviewed findings of revision arthroscopy cases performed for pain, stiffness, or weakness and found that in 23% of these revision cases intraoperative cultures were positive for C. acnes growth.…”

Section: Discussionmentioning

confidence: 99%

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

Nadig

Shaw

Parada

2019

Journal Orthopaedic Research

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Cutibacterium acnes (C. acnes) is a significant insidious pathogen for postoperative infections in shoulder surgery. Studies have demonstrated that certain topical antibiotic powders used have the potential for chondrotoxicity. Benzylpenicillin, commonly referred to as Penicillin G (Pen G) has the lowest minimum inhibitory concentration (MIC) for C. acnes. There is no research regarding the topical application of Pen G during shoulder surgery, nor has its chondrocyte toxicity been previously investigated. This study sought to characterize the in vitro chondrocyte toxicity of Pen G. Culture‐derived bovine chondrocytes were exposed to serial Pen G concentrations and compared with a positive and negative control. A negative control of growth medium and positive control of 1% Triton solution. The chondrocyte viability was assessed via spectrophotometer absorbance. The treatment groups were analyzed using one‐way repeated measures analysis of variance and Pearson's correlation analysis. The chondrocyte viability was significantly higher for all Pen G concentrations as compared with the positive control (p < 0.001). All concentrations of Pen G exhibited continued chondrocyte metabolic activity over time. Analysis of variance, independent of time, demonstrated no significant decrease in chondrocyte viability for Pen G concentrations ≤6.25 mg/ml, as compared with the negative control (p > 0.05). Pen G demonstrated a significant negative correlation with its concentration and absorbance (r = 0.371, p < 0.001), however, concentrations ≤6.25 mg/ml did not demonstrate a significant decrease in chondrocyte viability (p = 0.063). Pen G in concentrations appropriate for C. acnes is not significantly chondrotoxic and may be safe for intrawound application. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:726‐730, 2020

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Section: Discussionmentioning

confidence: 99%

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

Nadig

Shaw

Parada

2019

Journal Orthopaedic Research

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“…Although primarily recognised for its role in acne, P. acnes is an anaerobic Gram-positive bacterium that forms part of the normal flora of the skin9 10 and has emerged as a common cause of infections after shoulder arthroplasty and non-arthroplasty surgeries 11–16. But infections after shoulder surgeries and subacromial corticosteroid injections reported >15 years ago were more often attributed to Staphylococcus aureus , S. epidermidis and other Staphylococcus or Streptococcus species 5 8 17–19.…”

Section: Discussionmentioning

confidence: 99%

“…During that era, P. acnes was often considered to be a contaminant 13 20. Since then P. acnes has become recognised as an increasingly common postoperative and postinjection pathogen of the shoulder region 11–16 21–23. For example, Athwal et al 13 reported on 39 deep infections after conventional open or mini-open rotator cuff repairs in 4886 patients who had surgeries performed between 1975 and 2003.…”

Section: Discussionmentioning

confidence: 99%

“…P. acnes was present in six of seven patients (86%) with infections. Other causes of bacterial infections after these types of non-arthroplasty procedures include S. aureus , S. epidermidis , Staphylococcus warneri , Staphylococcus haemolyticus , Staphylococcus saccharolyticus, Micrococcus luteus , Achromobacter denitrificans , Peptostreptococcus magnus , Bacillis species, Corynebacterium species, Streptococcus species and Pseudomonas species 8 12 13 15 16 22–24…”

Section: Discussionmentioning

confidence: 99%

“…P. acnes might have persisted at that time but just failed to grow by the 14th day that the cultures were held. Although growth of this organism usually requires 9–14 days,34 35 growth can take longer in some cases and this depends on various factors including the presence of a polymicrobial infection, characteristics of the tissue or fluid tested and the culture media used 12 36 37. By contrast, S. epidermidis usually grows within 4 days 12 38.…”

Section: Discussionmentioning

confidence: 99%

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Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection

et al. 2018

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In September 2015, a male aged 61 years with poorly controlled diabetes (his only medical problem) had left shoulder surgery that included an arthroscopic acromioplasty with debridement of suture material from a rotator cuff repair done 10 years prior. A subacromial corticosteroid injection was given 7 months later for pain and reduced motion. Three weeks later a fulminate infection was evident. Cultures grew Propionibacterium acnes. Treatment included two arthroscopic debridement surgeries and 8 weeks of intravenous antibiotics (primarily daptomycin). Eight weeks after the cessation of the antibiotics, purulence recurred and tissue cultures then grew Staphylococcus epidermidis. Several additional surgeries were needed to control the infection. We failed to recognise that an abscess that extended from the subacromial space across the entire supraspinous fossa. We report this case to alert clinicians that a seemingly innocuous subacromial corticosteroid injection can lead to an atypical infection and also extend into the supraspinous fossa.

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Lack of level I evidence on how to prevent infection after elective shoulder surgery

Eck

Neumann

Limpisvasti

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Low-grade infections in nonarthroplasty shoulder surgery

Cited by 23 publications

References 57 publications

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection

Lack of level I evidence on how to prevent infection after elective shoulder surgery

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