Friday, March 15, 2013

Propionibacterium in revision shoulders - more!

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

Propionibacterium is being recovered frequently in cases of revision shoulder arthroplasty. These authors conducted a retrospective review of 55 patients who underwent revision shoulder arthroplasties; 40 of which had standard preparations with adhesive, iodine-barrier drapes and 15 had placement of cyanoacrylate microbial sealant in addition to the standard preparation. 7 of the 40 with the standard preparation and 1 of the 15 had positive cultures. Six of the seven and one of one of the positive cultures were positive for Propionibacterium acnes. Fisher's exact test p for the difference is 0.42.

Our current thinking is that Propionibacterium lies within the sebaceous glands and hair follicles. From this site, it gets into our surgical incisions from the dermal incision. Thus we're unsure that sealing the skin will be effective in reducing wound contamination.

What is striking in this article is their summary of the recent literature on Propionibacterium positive cultures in revision shoulder arthroplasty:

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