Monday, January 29, 2018

Propionibacterium frequently contaminate rotator cuff repairs

Propionibacterium acnes Suture Contamination in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Study

This author sought to examine the contamination rate of the anchor-suture and determine the efficacy of two different surgical skin preparation solutions with or without a plastic adhesive drape from suture contamination in arthroscopic rotator cuff repair. 

He undertook a prospective randomized study evaluating 126 consecutive patients undergoing arthroscopic rotator cuff repair. Each shoulder was prepared with one of 2 randomly selected solutions: chlorhexidine-alcohol or povidone-iodine. Then, each group was further divided according to the usage of a plastic drape. 

The first cut-tails of the anchor-suture after cuff fixation were submitted to aerobic and anaerobic cultures.

The overall rate of Propionibacterium positive cultures was 
47% in the povidone-iodine group, 
33%  in the povidone-iodine with a drape group, 
33% in the chlorhexidine-alcohol group, and
9.3% in the chlorhexidine-alcohol with a drape group. 

No other bacteria were isolated, and no infections occurred in any of the patients treated in this study during the minimum 12-month follow-up period. 

Comment: The suggestion is that the sutures become contaminated by contact with the skin during the repair procedure.

This study indicates that, despite precautions, Propionibacterium are commonly introduced into arthroscopic surgical wounds. The effects of this inoculation on the outcome of the surgery - for example on the healing of the cuff repair -  remains to be determined.