Propionibacterium acnes infection in shoulder arthroscopy patients with postoperative pain

J Shoulder Elbow Surg. 2015 Jun;24(6):838-43. doi: 10.1016/j.jse.2015.03.008.

Abstract

Background: Recent studies have identified Propionibacterium acnes as the causal organism in an increasing number of postoperative shoulder infections. Most reports have found a high rate of P acnes infection after open surgery, particularly shoulder arthroplasty. However, there are limited data regarding P acnes infections after shoulder arthroscopy.

Materials and methods: We prospectively collected data on all shoulder arthroscopies performed by the senior author from January 1, 2009, until April 1, 2013. Cultures were taken in all revision shoulder arthroscopy cases performed for pain, stiffness, or weakness. In addition, 2 cultures were taken from each of a cohort of 32 primary shoulder arthroscopy cases without concern for infection to determine the false-positive rate.

Results: A total of 1,591 shoulder arthroscopies were performed during this period, 68 (4.3%) of which were revision procedures performed for pain, stiffness, or weakness. A total of 20 revision arthroscopies (29.4%) had positive culture findings, and 16 (23.5%) were positive for P acnes. In the control group, 1 patient (3.2%) had P acnes growth.

Conclusions: The rate of P acnes infection in patients undergoing revision shoulder arthroscopy is higher than previously published and should be considered in cases characterized by refractory postoperative pain and stiffness.

Keywords: Propionibacterium acnes; arthroscopic surgery; complications; infection; pain; revision surgery; stiffness; synovitis.

MeSH terms

  • Adult
  • Aged
  • Arthroplasty / adverse effects
  • Arthroscopy*
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Gram-Positive Bacterial Infections / diagnosis
  • Gram-Positive Bacterial Infections / epidemiology*
  • Gram-Positive Bacterial Infections / therapy
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pain, Postoperative / microbiology*
  • Pain, Postoperative / pathology
  • Pain, Postoperative / surgery
  • Propionibacterium acnes*
  • Reoperation
  • Shoulder Joint*
  • Synovitis / microbiology*
  • Synovitis / pathology
  • Synovitis / surgery