Single-Stage Revision Is Effective for Failed Shoulder Arthroplasty with Positive Cultures for Propionibacterium

Hsu, Jason E.; Gorbaty, Jacob D.; Whitney, Ian J.; Matsen, Frederick A.

doi:10.2106/jbjs.16.00149

Cited by 72 publications

(36 citation statements)

References 17 publications

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“…Previous reports on Cutibacterium IAI predominantly described shoulder PJI [ 12 – 15 ]. In this cohort, we report a high proportion of infection located on lower extremities, mainly hip PJI.…”

Section: Discussionmentioning

confidence: 99%

“…In the presence of an implant, Cutibacteria are increasingly recognized as the causative pathogen of low-grade infections affecting cardiovascular devices [ 4 ], breast implants [ 5 ], neurosurgical shunts [ 6 ], ocular implants [ 7 ], internal fracture fixation devices [ 8 ], spinal hardware [ 9 , 10 ] and joint prostheses [ 11 ]. They claimed attention particularly in infections after shoulder arthroplasty [ 12 – 16 ], spine surgery [ 9 , 10 ] and craniotomy [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

et al. 2018

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BackgroundThe definition criteria and clinical characteristics of implant-associated infection (IAI) caused by Cutibacterium (formerly Propionibacterium) spp. are poorly known. We analyzed microbiologically proven Cutibacterium orthopedic IAI in a prospective cohort.MethodsPatients with periprosthetic joint infections (PJI) and fixation device–associated infections (FDAI) caused by Cutibacterium spp. were prospectively included. IAI was defined by significant growth of Cutibacterium spp. and presence of at least one non-microbiological criterion for infection. The McNemar’s chi-squared or binomial test was used to compare the performance of diagnostic tests.ResultsOf 121 patients with Cutibacterium IAI, 62 patients (51%) had PJI and 59 (49%) had FDAI. 109 infections (90%) were caused by C. acnes and 12 (10%) by C. avidum. The median time from implantation until diagnosis of infection was 15.7 months (interquartile range, 5–46.5 months). Clinical local signs were present in 30 patients (28%) and radiological implant loosening in 64 patients (63%). Culture sensitivity of sonication fluid was 84%, of peri-implant tissue 84% and of synovial or peri-implant fluid 56% after 14 days of incubation.ConclusionCutibacterium IAI was diagnosed late in the disease course and presented with subtle signs. Prolonged culture incubation and implant sonication improved the poor performance of conventional microbiological tests. Due to lack of reliable diagnostic tests, Cutibacterium remains difficult to detect making the diagnosis challenging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

et al. 2018

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“…Nevertheless, the additional expense of a two-stage revision was invested to achieve this high level of infection control. However, if the infection control of our cohort is compared with those of single-stage exchange studies, the success rates seems comparable [3,12], which would tend to favor a single-stage strategy with less morbidity and comparable infection control rates even for patients in whom the bacteria is unknown [3,16].…”

Section: Discussionmentioning

confidence: 85%

Staged Revision With Antibiotic Spacers for Shoulder Prosthetic Joint Infections Yields High Infection Control

Grubhofer

Imam

Wieser

et al. 2018

Clin Orthop Relat Res

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“…C. acnes is increasingly recognized as a prime causative agent of shoulder septic prosthetic arthritis and associated humeral osteomyelitis 21, 26, 29, 30, 32, 35. Multiple reports have documented the thorough and meticulous microbiologic technique needed to culture this fastidious organism when joint infection is suspected 8, 25, 38.…”

Section: Discussionmentioning

confidence: 99%

Cutibacterium (formerly Propionibacterium) acnes clavicular infection

Zaid

Chavez

Carrasco

et al. 2019

J. Bone Joint Infect.

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Cutibacterium (formerly Propionibacterium) acnes13, 16 is a slow growing, gram-positive bacteria that is naturally found in higher concentrations as skin flora on the chest and back, as well as in other areas with greater numbers of hair follicles.25, 37 Most of the reported cases of C. acnes shoulder girdle infection follow arthroplasty surgery,18, 20, 26, 27, 32, 35 which then often requires debridement, administration of intravenous antibiotics, and surgical revision of the implanted device.12, 15, 21, 28-30 In a recent study, 56% of 193 shoulder revisions had a positive culture, 70% of which grew C. acnes.30 Despite the relatively common presumed association of C. acnes humeral osteomyelitis with prosthetic infection, infection of the scapula or clavicle secondary to C. acnes is rare.4, 23, 36 Osteomyelitis of the clavicle involving any organism is also an uncommon event that can arise spontaneously via presumed hematogenous spread, or secondary to open fractures or internal fixation.6, 33 The most commonly found organism in clavicular osteomyelitis is Staphylococcus aureus.9 We here report two cases of clavicular infection secondary to C. acnes that were not associated with implants.

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Single-Stage Revision Is Effective for Failed Shoulder Arthroplasty with Positive Cultures for Propionibacterium

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

Cited by 72 publications

References 17 publications

Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

Staged Revision With Antibiotic Spacers for Shoulder Prosthetic Joint Infections Yields High Infection Control

Cutibacterium (formerly Propionibacterium) acnes clavicular infection

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