These authors sought to determine the presence of Cutibacterium acnes (formerly Propionibacterium acnes) on the skin and in deep tissue in a 90 primary reverse shoulder arthroplasties.
Twelve cultures were obtained from each patient:
1 and 2: punch biopsies of the skin (dermis and subcutaneous tissue) adjacent to the planned incision after the skin was prepared
3: subcutaneous tissue biopsy after incision
4 and 5: bursa over the greater tuberosity
6 and 7: glenoid tissue around the long head of the biceps insertion
8 and 9: glenoid after prosthesis implantation
10 and 11: humerus after prosthesis implantation
12: subcutaneous tissue at the close of the case.
In 17 patients there were 22 C acnes–positive tissue cultures before prosthesis implantation and 40 after implantation.
Many of the clusters isolated belonged to phylotype IB, K1 and K2 subtypes, and clonal complex (CC) 36 or phylotype II and CC53. These types are commonly involved in prosthetic joint infection.
Comment: This study adds to the literature demonstrating that, despite careful skin preparation and intravenous antibiotics, Propionibacterium can be recovered from skin and deep tissues at the time of primary arthroplasty.
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