Cutibacterium acnes and the shoulder microbiome
These authors used DNA sequencing technologies to gain insights into the likely sources of Cutibacterium acnes (formerly Propionibacterium acnes) infections within the shoulder. Basically, their question was "do normal deep tissues of the shoulder harbor low levels of Propionibacterium that could be stimulated to grow by surgery?"
They collected tissue samples were collected from the skin, subcutaneous fat, anterior supraspinatus tendon, middle glenohumeral ligament, and humeral head cartilage of 23 patients (14 male and 9 female patients) during primary arthroplasty surgery. All samples were collected in operating rooms with vertical laminar airflow and micro-particulate air filtration, a new sterile scalpel blade was used for the collection of each tissue sample, and a fresh sterile hemostat was used to grasp and transfer the tissue into a prelabeled sterile 50-mL Falcon tube containing 6 mL of nuclease-free water
Total DNA was extracted and microbial 16S ribosomal RNA sequencing was performed using an Illumina MiSeq system.
Data analysis software was used to generate operational taxonomic units for quantitative and statistical analyses.
After stringent removal of contamination, genomic DNA from various Acinetobacter species and
from the Oxalobacteraceae family was identified in 74% of rotator cuff tendon tissue samples.
C acnes (Propionibacterium) DNA was detected in the skin of 1 male patient but not in any other shoulder tissues.
Their findings indicated the presence of a low-abundance microbiome in the rotator cuff and, potentially, in other shoulder tissues. The absence of C acnes DNA in all shoulder tissues assessed other than the skin is consistent with the hypothesis that C acnes infections are derived from skin contamination during surgery and not from opportunistic expansion of a resident C acnes population residing in the shoulder joint.
Comment: While this is an interesting study, it is curious that C acnes (Propionibacterium) DNA was recovered form the skin of only one of 14 male subjects. This rate is much lower than what would be expected based on prior culture-based studies and makes one wonder about the sensitivity of the methods used in this study.
See for example
Propionibacterium persists in the skin despite standard surgical preparation
Background: Propionibacterium acnes, which normally resides in the skin, is known to play a role in surgical site infection in orthopaedic surgery. Studies have suggested a persistence of propionibacteria on the skin surface, with rates of positive cultures ranging from 7% to 29% after surgical preparation. However, as Propionibacterium organisms normally reside in the dermal layer, these studies may underestimate the true prevalence of propionibacteria after surgical skin preparation. We hypothesized that, after surgical skin preparation, viable Propionibacterium remains in the dermis at a much higher rate than previously reported. Methods: Ten healthy male volunteers underwent skin preparation of the upper back with ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol). Two 3-mm dermal punch biopsy specimens were obtained through the prepared skin and specifically cultured for P. acnes. Results: Seven volunteers had positive findings for Propionibacterium on dermal cultures after ChloraPrep skin preparation. The average time to positive cultures was 6.78 days. Conclusions: This study found that Propionibacterium persists in the dermal tissue even after surface skin preparation with ChloraPrep. The 70% rate of persistence of propionibacteria after skin preparation is substantially higher than previously reported.
https://www.medscape.com/medline/abstract/25187583
These authors used DNA sequencing technologies to gain insights into the likely sources of Cutibacterium acnes (formerly Propionibacterium acnes) infections within the shoulder. Basically, their question was "do normal deep tissues of the shoulder harbor low levels of Propionibacterium that could be stimulated to grow by surgery?"
They collected tissue samples were collected from the skin, subcutaneous fat, anterior supraspinatus tendon, middle glenohumeral ligament, and humeral head cartilage of 23 patients (14 male and 9 female patients) during primary arthroplasty surgery. All samples were collected in operating rooms with vertical laminar airflow and micro-particulate air filtration, a new sterile scalpel blade was used for the collection of each tissue sample, and a fresh sterile hemostat was used to grasp and transfer the tissue into a prelabeled sterile 50-mL Falcon tube containing 6 mL of nuclease-free water
Total DNA was extracted and microbial 16S ribosomal RNA sequencing was performed using an Illumina MiSeq system.
Data analysis software was used to generate operational taxonomic units for quantitative and statistical analyses.
After stringent removal of contamination, genomic DNA from various Acinetobacter species and
from the Oxalobacteraceae family was identified in 74% of rotator cuff tendon tissue samples.
C acnes (Propionibacterium) DNA was detected in the skin of 1 male patient but not in any other shoulder tissues.
Their findings indicated the presence of a low-abundance microbiome in the rotator cuff and, potentially, in other shoulder tissues. The absence of C acnes DNA in all shoulder tissues assessed other than the skin is consistent with the hypothesis that C acnes infections are derived from skin contamination during surgery and not from opportunistic expansion of a resident C acnes population residing in the shoulder joint.
Comment: While this is an interesting study, it is curious that C acnes (Propionibacterium) DNA was recovered form the skin of only one of 14 male subjects. This rate is much lower than what would be expected based on prior culture-based studies and makes one wonder about the sensitivity of the methods used in this study.
See for example
Propionibacterium persists in the skin despite standard surgical preparation
Background: Propionibacterium acnes, which normally resides in the skin, is known to play a role in surgical site infection in orthopaedic surgery. Studies have suggested a persistence of propionibacteria on the skin surface, with rates of positive cultures ranging from 7% to 29% after surgical preparation. However, as Propionibacterium organisms normally reside in the dermal layer, these studies may underestimate the true prevalence of propionibacteria after surgical skin preparation. We hypothesized that, after surgical skin preparation, viable Propionibacterium remains in the dermis at a much higher rate than previously reported. Methods: Ten healthy male volunteers underwent skin preparation of the upper back with ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol). Two 3-mm dermal punch biopsy specimens were obtained through the prepared skin and specifically cultured for P. acnes. Results: Seven volunteers had positive findings for Propionibacterium on dermal cultures after ChloraPrep skin preparation. The average time to positive cultures was 6.78 days. Conclusions: This study found that Propionibacterium persists in the dermal tissue even after surface skin preparation with ChloraPrep. The 70% rate of persistence of propionibacteria after skin preparation is substantially higher than previously reported.
https://www.medscape.com/medline/abstract/25187583
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