Thursday, December 4, 2014

Do Propionibacterium prefer suture?

This is an x-ray of a shoulder with pain and stiffness after a prior arthroscopic suture of the labrum to the glenoid in 2007. Note the cystic lesions of the humeral head and glenoid. 

There were no clinical signs of infection. The patient was scheduled for a ream and run procedure. At the procedure antibiotics were withheld until cultures could be obtained. Six sutures were seen to extend from six cystic areas on the glenoid face. The sutures and tissue from the cysts were sent for culture. There was no apparent infection at surgery. His postoperative films are shown below. He was discharged on oral Augmentin and placed on the routine ream and run rehabilitation program.

Ten days after surgery his cultures turned positive for Propionibacterium. He was started on IV Ceftriaxone X 6 weeks and then placed back on Augmentin. He is continuing with his rehabilitation program and making good progress. 

We thought it was interesting that each of the four sutures were culture positive for Propionibacterium whereas neither of the tissue specimens were culture positive at 26 days (see below).

This result suggests that suture may create a 'safe harbor' for the formation of a Propionibacterium-containing biofilm. It also suggests that suture within a wound may be a good specimen to send for culture.



To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'