Now, however, clinical scientists point out that Cutibacterium is the organism most commonly associated with periprosthetic infections of the shoulder. And, furthermore, Cutibacterium has the ability to persist in prosthetic wounds, in spite of prophylaxis, surgical treatment and antibiotic management.
This persistence is likely to multifactorial, related in part to the large amounts of this organism on the skin, the host's inability to recognize Cutibacterium as "a foreign invader", and the ability of this organism to form biofilms that protect it from antibiotics and immune response.
Recently, the authors of Cutibacterium acnes invades submicron osteocyte lacuno‐canalicular networks following implant‐associated osteomyelitis uncovered more information bearing on the challenge of eliminating this organism from arthroplasty wounds. They developed an implant-associated osteomyelitis model in which mice were subjected to transtibial implantation of titanium or stainless-steel pins contaminated with Cutibacterium. Using in vitro scanning electron microscopy (EM) they confirmed that Cutibacterium can form biofilms on stainless-steel and titanium implants - two of the common metals used in prosthetic implants. In their model, Cutibacterium persisted for 28 days not only in the tibia but that it also disseminated to internal organs.
Recently, the authors of Cutibacterium acnes invades submicron osteocyte lacuno‐canalicular networks following implant‐associated osteomyelitis uncovered more information bearing on the challenge of eliminating this organism from arthroplasty wounds. They developed an implant-associated osteomyelitis model in which mice were subjected to transtibial implantation of titanium or stainless-steel pins contaminated with Cutibacterium. Using in vitro scanning electron microscopy (EM) they confirmed that Cutibacterium can form biofilms on stainless-steel and titanium implants - two of the common metals used in prosthetic implants. In their model, Cutibacterium persisted for 28 days not only in the tibia but that it also disseminated to internal organs.
Transmission EM revealed the presence of Cutibacterium within bone canaliculi. These data revealed that the osteocyte lacuno-canalicular networks can serve as a sheltered reservoir in which Cutibacterium can persist long after inoculation.
This adds yet another possible mechanism explaining why Cutibacterium chronic implant-associated bone infections can be delayed in their presentation and difficult to treat.
One of the striking features of this work is that it demonstrates biofilm formation with bacterial adherence to the pin surface as early as 3 hours after implantation. Progressive biofilm formation was seen with increasing pin incubation time as shown below
The recovery of Cutibacterium from bone, soft tissue, liver, kidneys, heart and spleen at 28 days after implantation demonstrates the systemic spread of the organism and inability of the host to resolve the infection.
Comment: Cutibacterium can now be recognized as a virulent bacteria because of its high ability to cause disease - in part because it evades the host' immune system and in part because of its defense mechanisms, including biofilm formation and, as suggested in this article reporting on results from a murine model, its ability to colonize bone canaliculi.
The dermal pilosebaceous units of the skin overlying the shoulder - especially those in young men - are loaded with Cutibacterium. Investigations have shown that skin preparations are not effective in eliminating Cutibacterium from the dermis. Thus the incisions used for shoulder arthroplasty routinely allow Cutibacterium to enter the wound and potentially participate in the formation of a biofilm on the surface of the implant.
Further research is needed to define ways to reduce the bacterial load that is introduced at the time of arthroplasty as well as the risk of subsequent biofilm formation.
Comments welcome at shoulderarthritis@uw.edu
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link
Follow on twitter/X: https://x.com/RickMatsen
Follow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
