Friday, January 26, 2018

Propionibacterium found in primary arthroscopy. Does skin preparation work?

Prevalence of Propionibacterium acnes in the glenohumeral compared with the subacromial  space in primary shoulder arthroscopies

These authors studied 115 patients (54.8% men; mean age, 47.2 ± 14.6 years) with normal preoperative C reactive protein aged 18 years or older with shoulder arthroscopies without prior shoulder operations, complete rotator cuff tears, systemic inflammatory diseases, tumors, shoulder injections within 6 months of surgery, or antibiotic therapy within 14 days preoperatively. 

Five minutes after standardized skin disinfection with Kodan Tinktur Forte Gefärbt, a skin swab was taken at the posterior portal. Arthroscopy was performed without cannulas, prospectively randomized to start either in the glenohumeral space or in the subacromial space, with direct harvesting of a soft-tissue biopsy specimen at the beginning of the procedure. The glenohumeral space was sampled with a Johnson jaws grasper forceps inserted through an anterior portal (+) while the subacromial space was sampled through a lateral portal (*). 

Propionibacterium were detected on the skin immediately after disinfection in 36.5% of patients.

Propionibacterium were detected in 18.9% of the glenohumeral samples and in 3.5% of the subacromial samples.

Comment: This study again demonstrates that surgical skin preparation does not eliminate Propionibacterium. 

While the authors conclude that the prevalence of Propionibacterium is significantly higher in the glenohumeral space compared with the subacromial space in primary shoulder arthroscopies, each of the two compartments were biopsied through different approaches (anterior and lateral) and cannulas were not used. Thus it is possible that the insertion of the biopsy instrument through the anterior portal allowed the specimen to be in touch with and contaminated by a different area of Propionibacterium-containing dermis than the lateral approach to the subacromial space.

In any event this investigation shows that primary surgical wounds can be culture positive for Propionibacterium. These bacteria in the joint or subacromial space have the potential to inoculate suture or surgical implants with the subsequent formation of a durable biofilm.

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