Propionibacterium acnes infection as an occult cause of postoperative shoulder pain: a case series.
BACKGROUND
Infections after shoulder surgery are potentially devastating complications. Propionibacterium acnes is recognized as a causal agent in shoulder infections. The clinical presentation is usually insidious and nonspecific, but a P. acnes infection could be an occult cause of postoperative shoulder pain.


OBJECTIVE
What are the clinical and microbiologic characteristics of a postsurgical P. acnes shoulder infection and how should it be addressed?


METHODS
Ten patients with an average age of 57 years presented with P. acnes postsurgical shoulder infection. Clinical infection signs and surgical history were assessed and joint aspirates and tissue biopsy specimens were obtained. Diagnosis was confirmed by microbiologic cultures.


RESULTS
At the time of confirmation of the diagnosis, clinical signs of infection were absent. C-reactive protein and erythrocyte sedimentation rates were inconsistently elevated. Cultures took a mean 7 days to confirm organism growth. The average time from surgery to diagnosis of infection was 1.8 years (range, 0.07-8.0 years). All patients underwent irrigation and débridement and were treated with antibiotics for 6 weeks.


CONCLUSIONS
P. acnes shoulder infections should be considered as a cause for persistent, unexplained shoulder pain. Shoulder aspirations and tissue samples should be obtained. Surgical débridement and intravenous antibiotics are necessary treatment modalities.


METHODS
Level IV, Prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Steadman Phillipon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA. drmillett@steadmanclinic.net
Peter J
PJ
Millett
Yi-Meng
YM
Yen
Connie S
CS
Price
Marilee P
MP
Horan
Olivier A
OA
van der Meijden
Florian
F
Elser
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D003120:Colorado; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000382:microbiology*; D020069:Shoulder Pain / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents
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