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Management of Propionibacterium acnes infection after shoulder surgery

David Saper1, Nina Capiro1, Richard Ma2

  • 1Boston Medical Center, Department of Orthopaedic Surgery, Boston University School of Medicine, 720 Harrison Avenue - Suite # 808, Boston, MA, 02118, USA.

Current Reviews in Musculoskeletal Medicine
|January 19, 2015
PubMed

Insights

Propionibacterium acnes (P. acnes) causes difficult-to-diagnose shoulder infections. Optimal detection requires prolonged anaerobic cultures, and effective treatments include specific antibiotics and surgical revisions.

Area of Science:

  • Microbiology
  • Orthopedic Surgery
  • Infectious Diseases

Background:

  • Propionibacterium acnes (P. acnes) is a common skin bacterium.
  • P. acnes is an emerging pathogen causing postoperative shoulder infections after arthroscopy and arthroplasty.
  • Diagnosis is challenging due to normal inflammatory markers (white blood cells, erythrocyte sedimentation rate, C-reactive protein).

Purpose of the Study:

  • To highlight the diagnostic challenges of P. acnes shoulder infections.
  • To recommend optimal methods for P. acnes detection.
  • To review current and potential management strategies for P. acnes shoulder infections.

Main Methods:

  • Review of diagnostic criteria and risk factors for P. acnes shoulder infections.
  • Evaluation of microbiological culture techniques for P. acnes detection.
  • Analysis of treatment outcomes for various management strategies.

Main Results:

  • P. acnes infections present with normal laboratory values, complicating diagnosis.
  • Intraoperative frozen sections are unreliable for P. acnes detection.
  • Prolonged intraoperative cultures (minimum 13 days) in aerobic and anaerobic conditions improve detection rates.
  • Risk factors include male gender, cloudy synovial fluid, periprostular lucencies, and membrane formation.

Conclusions:

  • Extended anaerobic incubation of intraoperative cultures is crucial for diagnosing P. acnes shoulder infections.
  • Two-staged revision with open biopsy can detect persistent P. acnes.
  • Penicillin, cephalosporins, and combination therapy with rifampin and daptomycin show efficacy against P. acnes and its biofilms.

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