title: Management of Propionibacterium acnes infection after shoulder surgery.
abstract: Propionibacterium acnes (P. acnes) is a gram-positive anaerobic bacillus commonly isolated from the flora of the face, chest, and axilla region. It has emerged as a major pathogen responsible for postoperative shoulder infections after both arthroscopy and arthroplasty procedures. Patients with P. acnes shoulder infection typically present with normal laboratory values (white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)) making diagnosis difficult. Several intraoperative tissue cultures should be obtained and cultured in both agar plate and broth in aerobic and anaerobic conditions for a minimum of 13 days to optimize the sensitivity and specificity to detect P. acnes. The utilization of intraoperative frozen sections to detect P. acnes infection is not reliable. Risk factors include male, cloudy synovial fluid, lucencies around the implant, and periprosthetic membrane formation. Managements include irrigation and debridement, single or two-staged revision, and intravenous antibiotics. Open biopsy prior to the final implantation (two-staged revision) may help detect persistent P. acnes infection. Penicillin and cephalosporins are effective against clinical P. acnes infection and biofilm in vitro. Combination antibiotic therapy with rifampin and daptomycin may further increase the clinical efficacy of treatment.
authors.affiliation: Boston Medical Center, Department of Orthopaedic Surgery, Boston University School of Medicine, 720 Harrison Avenue - Suite # 808, Boston, MA, 02118, USA.
authors.forename: David
authors.initials: D
authors.lastname: Saper
authors.affiliation: Boston Medical Center, Department of Orthopaedic Surgery, Boston University School of Medicine, 720 Harrison Avenue - Suite # 808, Boston, MA, 02118, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Capiro
authors.affiliation: Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Ma
authors.affiliation: Boston Medical Center, Department of Orthopaedic Surgery, Boston University School of Medicine, 720 Harrison Avenue - Suite # 808, Boston, MA, 02118, USA. xinning.li@gmail.com.
authors.forename: Xinning
authors.initials: X
authors.lastname: Li