Cutibacterium acnes in primary reverse shoulder arthroplasty: from skin to deep layers
These authors sought to determine the presence of Cutibacterium acnes on the skin and in deep tissue in 90 patients having primary reverse shoulder arthroplasty with using antibiotic prophylaxis and standard preoperative skin preparation with chlorhexidine. The 90 patients (74 women, 16 men) finally included were a mean age of 75 years. The indications for RSA were cuff-tear arthropathy in 58 patients, an acute fracture in 20, and fracture sequelae in 12.
These authors sought to determine the presence of Cutibacterium acnes on the skin and in deep tissue in 90 patients having primary reverse shoulder arthroplasty with using antibiotic prophylaxis and standard preoperative skin preparation with chlorhexidine. The 90 patients (74 women, 16 men) finally included were a mean age of 75 years. The indications for RSA were cuff-tear arthropathy in 58 patients, an acute fracture in 20, and fracture sequelae in 12.
12 cultures were obtained from each patient. Once the skin was prepared and before the skin incision was performed, 2 punch biopsies were taken from the skin at the edge of the incision Immediately after the skin incision was done, another subcutaneous tissue biopsy was obtained. Two samples were taken from the bursa over the greater tuberosity. Two samples were taken around the long head of the biceps insertion. After the components of the arthroplasty were in place, 2 samples were obtained from the glenoid, 2 from the humeral side, and 1 from the subcutaneous tissue.
Total DNAfrom C acnes isolates was extracted using the InstaGene Matrix method. The phylotype was determined, and single-locus sequence typing was done on all isolates.
Of the 1080 tissue cultures from the 90 patients, 62 of those tissue cultures (5.7%) were positive for C acnes. There were 22 C acnes–positive tissue cultures before prosthesis implantation and 40 after implantation. C acnes was isolated in 17 patients (18.8%).
Most of the cases with strongly positive deep cultures had positive skin cultures.
Of the 1080 tissue cultures from the 90 patients, 62 of those tissue cultures (5.7%) were positive for C acnes. There were 22 C acnes–positive tissue cultures before prosthesis implantation and 40 after implantation. C acnes was isolated in 17 patients (18.8%).
Most of the cases with strongly positive deep cultures had positive skin cultures.
Many of the clusters isolated belonged to phylotype IB and clonal complex (CC) 36 or phylotype II and CC53. The C acnes K1 and K2 subtypes were usually isolated.
One patient was diagnosed as having an infection 6 months after the surgery, the C acnes isolated in both the primary surgery and during the revision surgery belonged to the same K1 cluster (phylotype II, CC53).
Comment: This article demonstrates the presence of Cutibacterium in primary reverse arthroplasty performed on patients who are older than those usually considered at risk (young, active males).
The followup after surgery was a minimum of one year. The one infection noted in this series was diagnosed six months after surgery and that the bug cultured at the time of revision was apparently the same one isolated at the index surgery. We have noted that periprosthetic infections with Cutibaterium may present up to a decade after surgery, so longer term followup of the culture positive shoulders will be of interest.
One patient was diagnosed as having an infection 6 months after the surgery, the C acnes isolated in both the primary surgery and during the revision surgery belonged to the same K1 cluster (phylotype II, CC53).
Comment: This article demonstrates the presence of Cutibacterium in primary reverse arthroplasty performed on patients who are older than those usually considered at risk (young, active males).
The followup after surgery was a minimum of one year. The one infection noted in this series was diagnosed six months after surgery and that the bug cultured at the time of revision was apparently the same one isolated at the index surgery. We have noted that periprosthetic infections with Cutibaterium may present up to a decade after surgery, so longer term followup of the culture positive shoulders will be of interest.
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