The Utility and Cost of Atypical Cultures in Revision Shoulder Arthroplasty
These authors conducted a review of 237 revision shoulder arthroplasties performed on 189 patients.
Cultures were sent on 158/237 (66.7%) of the surgeries with an average of 2.2 specimens per surgery.
Positive cultures were found in 52/341 (15.2%) aerobic cultures and 36/331 (10.9%) anaerobic
cultures.
The most commonly isolated organism was Cutibacterium (42.2%), followed by MRSA (15.6%), coagulase-negative staphylococcus species (13.3%), and MSSA (12.2%).
None of the fungal or acid-fast cultures were positive.
The total billing charges for aerobic, anaerobic, fungal, and acid-fast cultures over the study period were $77,748, $23,832, $8,789, and $106,662, respectively, with fungal, and acid-fast cultures accounting for 53.2% of the total charges for all cultures.
For a single sample sent for all four culture types, atypical cultures account for 69% of the total amount charged.
Comment: This study again demonstrates that a substantial percentage of specimens obtained at the time of revision arthroplasty are culture positive for Cutibacterium or Staph species and that male sex is a risk factor for Cutibacterium culture positivity. Finally, it points out that cultures for fungal and acid fast organisms are not of value for routine revisions, perhaps being reserved only for perplexing cases of "culture negative" infections.
