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Propionibacterium acnes in shoulder surgery: true infection, contamination, or commensal of the deep tissue?

Robert Hudek1, Frank Sommer2, Martina Kerwat2

  • 1Rhön-Klinikum AG, Klinik für Schulterchirurgie, Bad Neustadt, Germany.

Journal of Shoulder and Elbow Surgery
|September 3, 2014
PubMed
Abstract

Insights

Propionibacterium acnes (P. acnes) was found in over a third of patients during shoulder surgery, often in deep tissues. The anterolateral approach and male gender increased the risk of P. acnes detection.

Area of Science:

  • Orthopedic Surgery
  • Microbiology
  • Infectious Disease

Background:

  • Propionibacterium acnes (P. acnes) is implicated in chronic shoulder surgery infections.
  • The role of P. acnes as a contaminant versus a deep-tissue commensal remains unclear.

Purpose of the Study:

  • To investigate the prevalence and location of P. acnes in intraoperative shoulder tissue samples.
  • To correlate P. acnes detection with preoperative subacromial injections, surgical approach, and patient gender.

Main Methods:

  • Intraoperative tissue samples (skin, superficial, deep) were collected from 118 patients undergoing first-time shoulder surgery.
  • Samples were cultured for P. acnes and other bacteria.
  • Data were analyzed in relation to subacromial injection, surgical approach (anterolateral vs. deltopectoral), and gender.

Main Results:

  • P. acnes was detected in 36.4% of patients.
  • P. acnes was found more frequently in deep tissues (13.6%) than superficial (7.6%) or skin (8.5%) samples.
  • The anterolateral surgical approach (27.1% vs. 9.3%) and male gender (81.4% vs. 18.6%) were associated with significantly higher P. acnes detection rates.
  • Subacromial injections showed no association with bacterial growth.

Conclusions:

  • P. acnes is prevalent in a significant portion of patients undergoing shoulder surgery.
  • Deep tissue P. acnes detection suggests a potential role beyond superficial contamination.
  • The anterolateral approach and male sex are risk factors for P. acnes presence in shoulder surgery.
Keywords:
Propionibacterium acnesanterolateral approachcommensalcontaminantdeltopectoral approachinfectionshoulder

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