Reinfection rates after 1-stage revision shoulder arthroplasty for patients with unexpected positive intraoperative cultures.
BACKGROUND
Recent studies have detailed the significance of indolent infections in revision shoulder arthroplasty, but little information is available to guide treatment strategies regarding patients with positive cultures without overt signs of infection. The primary purpose of this study was to determine recurrence rates of infection for patients undergoing revision shoulder arthroplasty who were not treated for infection but had positive intraoperative cultures.


METHODS
We retrospectively reviewed the results of 17 patients undergoing revision of a failed shoulder joint replacement with at least 1 positive intraoperative culture who were not treated for infection because of limited signs of infection before or at the time of revision surgery. These patients underwent 1-stage revision surgery without an extended intravenous antibiotic regimen.


RESULTS
The recurrence rate of infection for the 17 patients was 5.9%. The most common pathogen cultured at revision surgery was Propionibacterium acnes (10 of 17 [56%]), followed by coagulase-negative Staphylococcus species (6 of 17 [35%]).


CONCLUSIONS
We found that low-virulence and clinically unexpected infections treated with 1-stage revision have a low risk for recurrent infection. This study suggests that intensive antimicrobial treatment strategies may not be necessary to reduce recurrent infections in patients with positive intraoperative cultures, without overt clinical signs of infection before or during the revision surgery.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Matthew J
MJ
Grosso
Vani J
VJ
Sabesan
Jason C
JC
Ho
Eric T
ET
Ricchetti
Joseph P
JP
Iannotti
D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000382:microbiology* / Q000601:surgery*