ShoulderPropionibacterium acnes infection after shoulder arthroplasty: A diagnostic challenge
Section snippets
Materials and methods
The Investigational Review Board (IRB) of the Hospital for Special Surgery, New York, approved this study (IRB #26057).
During a 4-year period (2002-2006), 11 patients (8 men, 3 women) were diagnosed with P acnes infection after shoulder arthroplasty. To ensure that a positive culture represented infection rather than specimen contamination, 2 positive intraoperative specimens were required for infection diagnosis. The medical records of these 11 patients were analyzed and retrospectively
Results
In group I, the average WBC was 7,280 cells/L (range, 6,000-9,000 cells/L), the average ESR was 44.4 mm/h (range, 13-86 mm/h), and the average CRP was 3.42 mg/dL (range, 0.8-8.8 mg/dL). The normal values at our institution for ESR are 0 to 12 mm/h for men and 0 to 27 mm/h for women, and for CRP, less than 0.7 mg/dL. No patients presented with fever.
A mean of 0.8 débridements (range, 0-3) after the reimplantation were necessary for the eradication of infection. One patient required a second
Discussion
The shoulder is thought to have has a propensity for infection with P acnes because the organism is the dominant anaerobic bacteria isolated from healthy skin in moist areas such as the axilla.1, 17, 23 Until recently, the organism was thought to be a contaminant rather than a true pathogen. P acnes is known to be a common causative organism in infections after shoulder instability surgery22 and arthroplasty.23 Several authors have also reported that P acnes was the most common infecting
Disclaimer
No funding was necessary for this study. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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