Contamination of the Surgical Field with Propionibacterium acnes in Primary Shoulder Arthroplasty
Propionibacterium acnes is a common pathogen identified in postoperative shoulder infection. It has been shown to be present in culture specimens during primary shoulder arthroplasty; however, recent work has suggested that it is most likely to be a contaminant. Our aim was to identify the potential...
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Published in | Journal of bone and joint surgery. American volume Vol. 98; no. 20; p. 1722 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
19.10.2016
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Abstract | Propionibacterium acnes is a common pathogen identified in postoperative shoulder infection. It has been shown to be present in culture specimens during primary shoulder arthroplasty; however, recent work has suggested that it is most likely to be a contaminant. Our aim was to identify the potential sources of contamination in shoulder arthroplasty.
Tissue swabs were obtained for microbiological analysis from consecutive patients undergoing primary shoulder arthroplasty. Routine surgical technique was maintained, and 5 specimens were taken from different sites: (1) the subdermal layer, (2) the tip of the surgeon's glove, (3) the inside scalpel blade (used for deeper incision), (4) the forceps, and (5) the outside scalpel blade (used for the skin incision).
Forty patients (25 female patients and 15 male patients) were included. Thirteen (33%) of the 40 patients had at least 1 culture specimen positive for P. acnes. Two (8%) of the 25 female patients and 11 (73%) of the 15 male patients had ≥1 culture specimen positive for P. acnes. The most common site of growth of P. acnes was the subdermal layer (12 positive samples), followed by the forceps (7 positive samples), the tip of the surgeon's glove (7 positive samples), the outside scalpel blade (4 positive samples), and the inside scalpel blade (1 positive sample). There were 27 of 75 swabs that were positive on culture for P. acnes in male patients compared with 4 of 125 swabs in female patients. Male patients had 66 times (95% confidence interval, 6 to 680 times) higher odds of having a positive culture indicating subdermal colonization compared with female patients (p < 0.001).
P. acnes is a common contaminant of the surgical field in primary shoulder arthroplasty. The subdermal layer may be the source of this contamination, and the prevalence of P. acnes in the surgical wound may be due to the surgeon's manipulation with gloves and instruments. Our findings are consistent with those regarding the increased rates of P. acnes bacterial load and intraoperative growth in male patients compared with female patients.
P. acnes is likely to be spread throughout the surgical field from the subdermal layer via soft-tissue handling by the surgeon and instruments. Strategies need to be utilized to minimize this contact and to reduce the chance of colonization. |
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AbstractList | Propionibacterium acnes is a common pathogen identified in postoperative shoulder infection. It has been shown to be present in culture specimens during primary shoulder arthroplasty; however, recent work has suggested that it is most likely to be a contaminant. Our aim was to identify the potential sources of contamination in shoulder arthroplasty.
Tissue swabs were obtained for microbiological analysis from consecutive patients undergoing primary shoulder arthroplasty. Routine surgical technique was maintained, and 5 specimens were taken from different sites: (1) the subdermal layer, (2) the tip of the surgeon's glove, (3) the inside scalpel blade (used for deeper incision), (4) the forceps, and (5) the outside scalpel blade (used for the skin incision).
Forty patients (25 female patients and 15 male patients) were included. Thirteen (33%) of the 40 patients had at least 1 culture specimen positive for P. acnes. Two (8%) of the 25 female patients and 11 (73%) of the 15 male patients had ≥1 culture specimen positive for P. acnes. The most common site of growth of P. acnes was the subdermal layer (12 positive samples), followed by the forceps (7 positive samples), the tip of the surgeon's glove (7 positive samples), the outside scalpel blade (4 positive samples), and the inside scalpel blade (1 positive sample). There were 27 of 75 swabs that were positive on culture for P. acnes in male patients compared with 4 of 125 swabs in female patients. Male patients had 66 times (95% confidence interval, 6 to 680 times) higher odds of having a positive culture indicating subdermal colonization compared with female patients (p < 0.001).
P. acnes is a common contaminant of the surgical field in primary shoulder arthroplasty. The subdermal layer may be the source of this contamination, and the prevalence of P. acnes in the surgical wound may be due to the surgeon's manipulation with gloves and instruments. Our findings are consistent with those regarding the increased rates of P. acnes bacterial load and intraoperative growth in male patients compared with female patients.
P. acnes is likely to be spread throughout the surgical field from the subdermal layer via soft-tissue handling by the surgeon and instruments. Strategies need to be utilized to minimize this contact and to reduce the chance of colonization. |
Author | Dorrestijn, Oscar Donaldson, Matthew J Cass, Benjamin Smith, Margaret M Hudson, Bernard J Baba, Mohammed Kruse, Lisa M Young, Allan A Falconer, Travis M Figtree, Melanie C |
Author_xml | – sequence: 1 givenname: Travis M surname: Falconer fullname: Falconer, Travis M email: ssri@sydneyshoulder.com.au organization: Perth Orthopaedic & Sports Medicine Center, West Perth, Australia ssri@sydneyshoulder.com.au – sequence: 2 givenname: Mohammed surname: Baba fullname: Baba, Mohammed organization: Specialty Orthopaedics, Bella Vista, Australia – sequence: 3 givenname: Lisa M surname: Kruse fullname: Kruse, Lisa M organization: Sydney Shoulder Research Institute, St. Leonards, Australia – sequence: 4 givenname: Oscar surname: Dorrestijn fullname: Dorrestijn, Oscar organization: Sydney Shoulder Research Institute, St. Leonards, Australia – sequence: 5 givenname: Matthew J surname: Donaldson fullname: Donaldson, Matthew J organization: Sydney Shoulder Research Institute, St. Leonards, Australia – sequence: 6 givenname: Margaret M surname: Smith fullname: Smith, Margaret M organization: Raymond Purves Bone and Joint Research Laboratory, Kolling Institute of Medical Research (M.M.S.), and Microbiology Department (M.C.F. and B.J.H.), Royal North Shore Hospital, St. Leonards, Australia – sequence: 7 givenname: Melanie C surname: Figtree fullname: Figtree, Melanie C organization: Raymond Purves Bone and Joint Research Laboratory, Kolling Institute of Medical Research (M.M.S.), and Microbiology Department (M.C.F. and B.J.H.), Royal North Shore Hospital, St. Leonards, Australia – sequence: 8 givenname: Bernard J surname: Hudson fullname: Hudson, Bernard J organization: Raymond Purves Bone and Joint Research Laboratory, Kolling Institute of Medical Research (M.M.S.), and Microbiology Department (M.C.F. and B.J.H.), Royal North Shore Hospital, St. Leonards, Australia – sequence: 9 givenname: Benjamin surname: Cass fullname: Cass, Benjamin organization: Sydney Shoulder Specialists, St. Leonards, Australia – sequence: 10 givenname: Allan A surname: Young fullname: Young, Allan A organization: Sydney Shoulder Specialists, St. Leonards, Australia |
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SubjectTerms | Aged Aged, 80 and over Arthroplasty, Replacement, Shoulder - adverse effects Female Gram-Positive Bacterial Infections - etiology Gram-Positive Bacterial Infections - microbiology Humans Male Middle Aged Postoperative Complications - microbiology Propionibacterium acnes - isolation & purification Shoulder Joint - microbiology Shoulder Joint - surgery Skin - microbiology |
Title | Contamination of the Surgical Field with Propionibacterium acnes in Primary Shoulder Arthroplasty |
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