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Researchers identify risk factors for P. acnes in shoulder arthroplasty

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CHICAGO —  Researchers have identified the preoperative and intraoperative risk factors for Propionibacterium acnes in patients who underwent shoulder arthroplasty revisions, according to a study presented at the American Academy of Orthopaedic Surgeons Annual Meeting, here.

“The risk factors that we identified are male sex, osteolysis, humeral loosening preoperatively [and] intraoperatively, cloudy fluid, membrane formation and glenoid wear,” Winston J. Warme, MD, said. “When we held the antibiotics prior to obtaining our specimens, we had twice the chance of growing positive cultures than if we gave the antibiotics as normal.”

 

Winston J. Warme

The researchers correlated the results of Propionibacterium acnes cultures with their preoperative and intraoperative analyses of 193 patients who underwent shoulder arthroplasties for pain, loosening or stiffness. The investigators used regression models to pinpoint the risk factors for P. acnes infections.

Warme found 108 cultures positive for bacteria of which 70% grew P. acnes. Male gender, osteolysis and cloudy fluid increased the risk of P. acnes infection by 600% and the presence of humeral loosening, glenoid wear or membrane formation increased the risk of infection by 300%.

“Our current recommendations for managing these patients who come to us without signs of infections is to hold the antibiotics, débride the membrane thoroughly, get samples from different parts of the wound, five cultures at least, keeping the patient on amoxicillin clavulanate until their cultures come back at 3 weeks,” Warme said. “If there are risk factors, then we would also want to exchange the implant, use allograft impaction with vancomycin added and then keep the patient on IV antibiotics until the cultures come back.”
Reference:

Warme W. Paper #578. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 18-23, 2013; Chicago.

Disclosure: Warme is a speaker for Arthrex Inc. and DJ Orthopaedics, receives research or institutional support as a principal investigator for Pacific Medical, receives financial support from Arthrex Inc., DJ Orthopaedics and Smith & Nephew.