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Published on: December 3, 2017
Preoperative Skin Cultures Predict Periprosthetic Infections in Revised Shoulder Arthroplasties: A Preliminary Report
Frederick A Matsen1, Anastasia Whitson1, Jason E Hsu1
1Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington.
Abstract:
Current approaches do not provide a practical method for the accurate prediction of a Cutibacterium periprosthetic joint infection (PJI) in failed arthroplasties. Thus, surgeons revising failed arthroplasties must decide whether to exchange the implants and to institute antibiotic treatment without knowing the results of cultures of deep specimens obtained at the revision procedure. This study tests the hypothesis that the results of preoperative culture specimens of the skin surface obtained in the clinic can predict the presence of culture-positive Cutibacterium PJIs.
Methods:
Revision shoulder arthroplasties performed between October 3, 2017, and February 4, 2020, that had both preoperative clinic culture specimens and surgical culture specimens were included in this analysis. Culture results were assigned a value from 0 to 4. The percentage of the total skin bacterial load contributed by Cutibacterium (Cutibacterium percentage) was determined. To reduce concern about contamination, a robust criterion for culture-positive Cutibacterium PJI was applied: ≥2 surgical specimens with a Cutibacterium value of ≥1. The predictive values for a culture-positive Cutibacterium PJI were determined for a clinic skin culture Cutibacterium value of >1 and a clinic skin percentage of Cutibacterium of ≥75%.
Results:
Eighteen cases met the inclusion criteria; of these, 7 (6 male patients) met our criterion for a culture-positive Cutibacterium PJI. For all patients, a preoperative clinic skin Cutibacterium value of >1 predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 89%, and a clinic skin Cutibacterium percentage of ≥75% predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 94%. For male patients, a preoperative clinic skin Cutibacterium value of >1 predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 91%, and a clinic skin Cutibacterium percentage of ≥75% predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 100%.
Conclusions:
A simple culture specimen of the unprepared skin surface obtained in a clinic prior to revision shoulder arthroplasty may provide valuable assistance to surgeons planning a revision arthroplasty.
Level Of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Insights
Preoperative skin cultures can accurately predict Cutibacterium periprosthetic joint infection (PJI) in revision shoulder arthroplasty. This simple method aids surgeons in planning revision procedures for failed implants.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Accurate prediction of Cutibacterium periprosthetic joint infection (PJI) in failed arthroplasties remains a clinical challenge.
- Surgeons often lack definitive microbiological data at revision surgery, complicating treatment decisions.
Purpose of the Study:
- To evaluate the efficacy of preoperative clinic skin surface cultures in predicting culture-positive Cutibacterium PJIs.
- To test the hypothesis that skin bacterial load can serve as a reliable diagnostic indicator.
Main Methods:
- Analysis of 18 revision shoulder arthroplasties with preoperative clinic and surgical cultures.
- Quantification of Cutibacterium percentage from skin surface samples.
- Application of a robust criterion (≥2 surgical specimens with Cutibacterium value ≥1) for culture-positive PJI.
Main Results:
- A preoperative clinic skin Cutibacterium value >1 predicted PJI with 89% accuracy (91% in males).
- A clinic skin Cutibacterium percentage ≥75% predicted PJI with 94% accuracy (100% in males).
Conclusions:
- Preoperative skin cultures offer a practical and valuable tool for predicting Cutibacterium PJI.
- This approach can assist surgeons in making informed decisions for revision arthroplasty procedures.
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