Risk factors for increased shoulder Cutibacterium acnes burden

Abstract

Background Cutibacterium acnes is the primary cause of shoulder surgery infections, but the predisposition to larger skin counts and potentially higher risk for postoperative infection remains unclear. This study aimed to quantify risk factors influencing endogenous C. acnes burden and to compare counts among 4 shoulder sites. Methods C. acnes counts were quantified via a detergent scrub technique for 173 participants. Bivariate and multivariable stepwise linear regression statistical analyses were used to investigate the association of sex, age, ethnicity, degree of hirsutism, diabetes, smoking status, body mass index, and location with counts. A separate Wilcoxon rank-sum test was performed analyzing counts of East/Southeast Asians vs. all other ethnicities. Results Sex, age, degree of hirsutism, diabetes, smoking status, and body mass index were included in the multivariable stepwise linear regression analysis. The multiple regression analysis isolated individuals <40 years with the highest burden ( P = .001). Males had a 191% increase in C. acnes counts compared with females ( P = .001). Increased hirsutism was further indicated to be a risk factor for the male sex although not in a dose-dependent manner ( P = .027). Wilcoxon rank-sum test results found that East/Southeast Asians had the lowest load ( P = .019), although not significant in the multivariate model. Conclusion Surgical site C. acnes infections occur more frequently in younger males, and males <40 years with shoulder-specific hirsutism have the highest preoperative burden. East/Southeast Asians have lower raw counts of C. acnes compared with other ethnicities that may be related to less hirsutism.

Short-term outcomes of two-stage reverse total shoulder arthroplasty with antibiotic-loaded cement spacer for shoulder infection

“…This result might be attributed to ethnicity and incubation period for the detection of C. acnes. East or southeast Asians had the lowest detection rate of C. acnes compared with all other ethnicities [23]. The incubation period for organisms was routinely three days only in our institute, although a 13-14 day incubation period is essential for the detection of C. acnes [24].…”

Detecção de Cutibacterium acnes em amostras de tecidos de cirurgias limpas primárias do ombro – Parte II

“…The predominance of males in the findings of C. acnes has been previously reported by several studies. 2 3 14 15 Kaveeshwar et al 15 found a correlation between isolation of this agent and age lower than 40 years. The higher prevalence stake in males and young people are related to the more active production of the sebaceous glands in these individuals.…”

“…The higher prevalence stake in males and young people are related to the more active production of the sebaceous glands in these individuals. 15 Finally, Nagaya et al 16 showed that patients with an anesthetic risk score higher than ASA III had a higher risk of developing infection after shoulder arthroplasty. Interestingly, in our study we found a higher correlation of microorganism isolation in ASA I patients, with a tendency to isolate C. acnes .…”

Dynamics of skin microbiota in shoulder surgery infections

“…Pre-measurements of the patient´s immunological, microbial and cellular status would provide insights into the patient's susceptibility to infection. The choice of antibiotic Previous surgeries and preoperative corticosteroid injections- [8,18] Reverse total shoulder arthroplasty relative to total shoulder arthroplasty- [17] Long surgery duration or traumatic arthroplasties- [16] Limited antibiotic prophylaxis control of C. acnes- [17,60] Low penetration in deeper skin of pre-operational disinfection- [60,58] administered as prophylaxis should be based on the above measurements and a clinical evaluation of the patient. Implementing selective and personalized pre-operative skin preparationsdecided based on the patient's health, lifestyle, age, and sex and their individual immunological-microbial statuscould further minimize the likelihood of post-operative infections.…”

“…Cutibacterium acnes is part of the healthy skin microbiome, inhabits the pilosebaceous units in the deep skin and thus often evades pre-operative disinfection [59][60][61]. With a surgical incision, C. acnes gains access to deeper skin layers and soft tissue [62].…”