title: Neer Award 2017: A rapid method for detecting Propionibacterium acnes in surgical biopsy specimens from the shoulder.
abstract: BACKGROUND
  Propionibacterium (P) acnes infection of the shoulder after arthroplasty is a common and serious complication. Current detection methods for P acnes involve anaerobic cultures that require prolonged incubation periods (typically 7-14 days). We have developed a polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) approach that sensitively and specifically identifies P acnes in tissue specimens within a 24-hour period.
  
  
  METHODS
  Primers were designed to amplify a unique region of the 16S rRNA gene in P acnes that contained a unique HaeIII restriction enzyme site. PCR and RFLP analyses were optimized to detect P acnes DNA in in vitro cultures and in arthroscopic surgical biopsy specimens from patients with P acnes infections.
  
  
  RESULTS
  A 564 base-pair PCR amplicon was derived from all of the known P acnes strains. HaeIII digests of the amplicon yielded a restriction fragment pattern that was unique to P acnes. P acnes-specific amplicons were detected in as few as 10 bacterial cells and in clinical biopsy specimens of infected shoulder tissues.
  
  
  CONCLUSIONS
  This PCR-RFLP assay combines the sensitivity of PCR with the specificity of RFLP mapping to identify P acnes in surgical isolates. The assay is robust and rapid, and a P acnes-positive tissue specimen can be confirmed within 24 hours of sampling, facilitating treatment decision making, targeted antibiotic therapy, and monitoring to minimize implant failure and revision surgery.
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Holmes
authors.affiliation: Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Pena Diaz
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
authors.forename: George S
authors.initials: GS
authors.lastname: Athwal
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Faber
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Electronic address: dogorman@uwo.ca.
authors.forename: David B
authors.initials: DB
authors.lastname: O'Gorman
mesh_terms: D000328:Adult; D054458:Amplified Fragment Length Polymorphism Analysis; D000072228:Arthroplasty, Replacement, Shoulder; D001706:Biopsy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D012150:Polymorphism, Restriction Fragment Length; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012086:Reoperation; D012680:Sensitivity and Specificity; D012785:Shoulder Joint / Q000382:microbiology* / Q000473:pathology / Q000601:surgery
chemical_list: D012336:RNA, Ribosomal, 16S
keywords: PCR-RFLP; Propionibacterium acnes; arthroplasty; biopsy; complication; detection; infection; shoulder