title: Propionibacterium acnes in shoulder surgery: is loss of hair protective for infection?
abstract: BACKGROUND
  Propionibacterium acnes (P acnes) has been linked to chronic infections in shoulder surgery. It was recently observed during first-time shoulder surgery in healthy patients at a rate between 36% and 56%. Male gender and the anterolateral approach were reported risk factors. Because the skin biology greatly differs, we aimed to correlate skin complaints with P acnes-positive intraoperative cultures from different tissue layer samples in patients undergoing shoulder surgery for the first time.
  
  
  METHODS
  Intraoperative samples (1 skin, 1 superficial, 1 deep tissue, and 1 control sample) from 112 patients (70 men, 42 women; aged 59.2 years) were cultured. The association between the presence of P acnes in the deep or superficial tissue, or both, and 10 items of a validated preoperative questionnaire for skin pathology was explored.
  
  
  RESULTS
  The cultures were positive for P acnes in 38.4% (n = 43) of the cases. Skin samples were positive for P acnes in 8% (n = 9), superficial samples were positive in 23% (n = 26), and deep samples were positive in 30% (n = 34). Self-reported "loss of hair" was significantly negatively associated with the presence of P acnes in the superficial or deep tissue sample (P = .00028).
  
  
  CONCLUSIONS
  Patients who report having "loss of hair" show fewer P acnes-positive cultures in intraoperative tissue samples taken during open shoulder surgery. Whether this subgroup is at a lesser risk for P acnes infections remains to be substantiated.
  
  
  METHODS
  Basic Science Study; Microbiology.
authors.affiliation: Klinik für Schulterchirurgie, RHÖN-KLINIKUM AG, Bad Neustadt, Germany. Electronic address: robert@hudek.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Hudek
authors.affiliation: Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Phillipps-Universität Marburg, Marburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Sommer
authors.affiliation: Klinik für Schulterchirurgie, RHÖN-KLINIKUM AG, Bad Neustadt, Germany.
authors.forename: Ayman F
authors.initials: AF
authors.lastname: Abdelkawi
authors.affiliation: Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Phillipps-Universität Marburg, Marburg, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Kerwat
authors.affiliation: Institut für Medizinische Biometrie und Epidemiologie, Philipps-Universität Marburg, Marburg, Germany.
authors.forename: Hans-Helge
authors.initials: HH
authors.lastname: Müller
authors.affiliation: Klinik für Schulterchirurgie, RHÖN-KLINIKUM AG, Bad Neustadt, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Gohlke
mesh_terms: D000505:Alopecia / Q000150:complications*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology; D006801:Humans; D007239:Infections / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000382:microbiology*; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D012307:Risk Factors; D057566:Self Report; D012782:Shoulder / Q000382:microbiology / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D012867:Skin / Q000382:microbiology
keywords: P acnes; Propionibacterium acnes; hair; infection; loss of hair; shoulder; skin; surgery