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J Shoulder Elbow Surg. 2019 Jan 24. pii: S1058-2746(18)30774-2. doi: 10.1016/j.jse.2018.10.016. [Epub ahead of print]

Cutibacterium acnes in primary reverse shoulder arthroplasty: from skin to deep layers.

Author information

1
Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain. Electronic address: 86925@parcdesalutmar.cat.
2
Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
3
Bacteriology and Infection Control Unit, Centre Hospitalier Universitaire Nantes, Nantes University Hospital, Nantes, France; Center for Research in Cancerology and Immunology, Univervité de Nantes, Unit 1232, Nantes, France.

Abstract

BACKGROUND:

The aim of this study was to determine the presence of Cutibacterium acnes (formerly Propionibacterium acnes) on the skin and in deep tissue in a real clinical scenario of primary reverse shoulder arthroplasty.

METHODS:

This prospective study included 90 primary reverse shoulder arthroplasties, and 12 cultures were obtained from each patient. Each sample was homogenized and used to inoculate PolyVitex (bioMérieux, Marcy-l'Etoile, France) agar and Schaedler (bioMérieux) agar plates. The same procedure was also followed with a thioglycolate broth. Culture was considered positive for C acnes when 2 or more colonies were observed. Total DNA from C acnes isolates was extracted using the InstaGene Matrix (Bio-Rad Laboratories, Hercules, CA, USA) method. The phylotype was determined, and single-locus sequence typing was done on all isolates.

RESULTS:

We obtained 1080 tissue cultures from the 90 patients included, and 62 of those tissue cultures (5.7%) were positive for C acnes. There were 22 C acnes-positive tissue cultures before prosthesis implantation and 40 after implantation. C acnes was isolated in 17 patients (18.8%). We sent 38 positive samples for blinded phylotyping, single-locus sequence typing, and multi-locus sequence typing type determination. Many of the clusters isolated belonged to phylotype IB and clonal complex (CC) 36 or phylotype II and CC53.

DISCUSSION:

In the real scenario of patients undergoing primary reverse shoulder arthroplasty using antibiotic prophylaxis and standard preoperative skin preparation with chlorhexidine, C acnes was isolated in the deep layers of 18.8% of the patients. The C acnes K1 and K2 subtypes (belonging to phylotype II and CC53), reported to be commonly involved in prosthetic joint infection, were usually isolated.

KEYWORDS:

Cutibacterium acnes; Propionibacterium acnes; Reverse shoulder arthroplasty; complications; infection; primary surgery

PMID:
30685278
DOI:
10.1016/j.jse.2018.10.016

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