Skip to main content
SpringerLink
Log in

Shoulder periprosthetic joint infection caused by Propionibacterium acnes

A retrospective cohort study

Periprothetische Schultergelenkinfekte verursacht durch Propionibacterium acnes

Eine retrospektive Kohortenstudie

  • Original Contribution
  • Published:
Obere Extremität Aims and scope Submit manuscript

Abstract

Background

Propionibacterium acnes is increasingly recognized as an important cause of shoulder periprosthetic joint infection (PJI). We performed a retrospective cohort study of P. acnes shoulder PJI to analyze the clinical, diagnostic, and treatment characteristics.

Methods

Patients diagnosed with shoulder PJI caused by P. acnes were retrospectively analyzed in two university hospitals. Patient data were retrieved through chart review. The outcome was evaluated at patient follow-up visits.

Results

The study included 20 patients with shoulder PJI (median age, 65 years; range, 54–77 years); 75 % were males. The median time from prosthesis implantation to diagnosis of PJI was 34 months (range, 2–60 months). Most PJI (55 %) were diagnosed >24 months after arthroplasty, followed by delayed manifestation 3–24 months after arthroplasty in 30 %. The diagnosis of PJI was preoperatively confirmed in 50 % of patients and suspected in 20 %. Persistent pain was present in 90 %, local signs of inflammation in 60 %, and radiological signs of loosening in 70 % of patients. P. acnes was cultured in joint aspirate in 33 %, periprosthetic tissue in 60 %, and sonication fluid in 89 % of patients. In four patients, coinfection with coagulase-negative staphylococci was found. One-stage prosthesis exchange was performed in four patients (20 %) and two-stage exchange in 15 patients (75 %); in one patient the prosthesis was not re-implanted. After a median follow-up of 26 months (range, 12–47 months), 18 patients (90 %) showed no signs or symptoms of infection.

Conclusion

P. acnes PJI typically manifested several years after implantation. In 30 % of patients, PJI was not suspected before surgery. In patients with persistent pain or prosthesis loosening, low-grade PJI should be excluded, including infection caused by P. acnes.

Zusammenfassung

Hintergrund

Propionibacterium acnes wird zunehmend als wichtiges verursachendes Pathogen von Endoprotheseninfektionen des Schultergelenks erkannt. In dieser retrospektiven Kohortenstudie wurden klinische, diagnostische und therapeutische Charakteristika von Schulter-Endoprotheseninfektionen verursacht durch P. acnes analysiert.

Methoden

Patienten mit Schulter-EPI und Nachweis von P. acnes wurden in zwei Universitätskliniken analysiert. Die Daten wurden aus Patientenakten extrahiert. Der Behandlungserfolg wurde mittels klinischen Nachkontrolluntersuchungen erhoben.

Ergebnisse

In die Studie waren zwanzig Patienten (medianes Alter 65 Jahre; Zeitspanne 54–77 Jahre) mit Schulter-Endoprotheseninfektionen einbezogen, 75 % waren männlichen Geschlechts. Im Durchschnitt lagen 34 Monate zwischen Primärimplantation und Diagnosestellung (Zeitspanne 2–60 Monate). Die meisten Endoprotheseninfektionen (55 %) wurden >24 Monate nach Primärversorgung diagnostiziert, bei 30 % der Patienten nach 3–24 Monaten. Die Diagnose wurde präoperativ in 50 % der Fälle bestätigt und in 20 % der Fälle vermutet. Bei 90 % waren persistierende Schmerzen vorhanden, 60 % zeigten lokale Entzündungszeichen und bei 70 % wurde eine radiologische Lockerung festgestellt. P. acnes wurde bei 33 % im Gelenkpunktat, bei 60 % im periprothetischen Gewebe und bei 89 % der Patienten in der Sonikationsflüssigkeit nachgewiesen. Bei 4 Patienten (20 %) zeigte sich eine Koinfektion mit koagulase-negativen Staphylokokken. 4 Patienten (20 %) wurden mit einem einzeitigen Endoprothesenwechsel behandelt, bei 15 Patienten (75 %) wurde ein zweizeitiger Wechsel durchgeführt. Ein Patient hat die Reimplantation einer Endoprothese verweigert und der Spacer verblieb im Gelenk. Nach einem medianen Follow-up von 26 Monaten (Zeitspanne 12–47 Monate) zeigten 18 Patienten (90 %) keine Infektzeichen oder -symptome.

Schlussfolgerung

P. acnes Endoprotheseninfektionen treten typischerweise einige Jahre nach Primärversorgung auf. Bei 30 % der Patienten wurde vor der Operation keine Infektion vermutet. Bei Patienten mit persistierenden Schmerzen oder Frühlockerung der Endoprothese sollte eine Low-grade-Infektion ausgeschlossen werden, einschließlich durch P. acnes verursachte Infektionen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Grice EA, Segre JA (2011) The skin microbiome. Nat Rev Microbiol 9(4):244–253

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Portillo ME, Corvec S, Borens O, Trampuz A (2013) Propionibacterium acnes: an underestimated pathogen in implant-associated infections. Biomed Res Int 2013:804391

    Article  PubMed  PubMed Central  Google Scholar 

  3. Corvec S, Portillo ME, Pasticci BM, Borens O, Trampuz A (2012) Epidemiology and new developments in the diagnosis of prosthetic joint infection. Int J Artif Organs 35(10):923–934

    PubMed  Google Scholar 

  4. Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351(16):1645–1654

    Article  CAS  PubMed  Google Scholar 

  5. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR et al (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357(7):654–663

    Article  CAS  PubMed  Google Scholar 

  6. Portillo ME, Salvado M, Trampuz A, Siverio A, Alier A, Sorli L et al (2015) Improved diagnosis of orthopedic implant-associated infection by inoculation of sonication fluid into blood culture bottles. J Clin Microbiol 53(5):1622–1627

    Article  PubMed  PubMed Central  Google Scholar 

  7. Portillo ME, Salvado M, Sorli L, Alier A, Martinez S, Trampuz A et al (2012) Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure. J Infect 65(6):541–548

    Article  PubMed  Google Scholar 

  8. Achermann Y, Vogt M, Leunig M, Wust J, Trampuz A (2010) Improved diagnosis of periprosthetic joint infection by multiplex PCR of sonication fluid from removed implants. J Clin Microbiol 48(4):1208–1214

    Article  PubMed  PubMed Central  Google Scholar 

  9. Piper KE, Jacobson MJ, Cofield RH, Sperling JW, Sanchez-Sotelo J, Osmon DR et al (2009) Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol 47(6):1878–1884

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dodson CC, Craig EV, Cordasco FA, Dines DM, Dines JS, Dicarlo E et al (2010) Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg 19(2):303–307

    Article  PubMed  Google Scholar 

  11. Kanafani ZA, Sexton DJ, Pien BC, Varkey J, Basmania C, Kaye KS (2009) Postoperative joint infections due to Propionibacterium species: a case-control study. Clin Infect Dis 49(7):1083–1085

    Article  PubMed  Google Scholar 

  12. Mook WR, Garrigues GE (2014) Diagnosis and management of periprosthetic shoulder infections. J Bone Joint Surg Am 96(11):956–965

    Article  PubMed  Google Scholar 

  13. Rienmüller A, Borens O (2016) Propionibacterium prosthetic joint infection: experience from a retrospective database analysis. Eur J Orthop Surg Traumatol 26(4):429–434

  14. Trampuz A, Perka C, Borens O (2013) Prosthetic joint infection: new developments in diagnosis and treatment. Dtsch Med Wochenschr 138(31–32):1571–1573

    CAS  PubMed  Google Scholar 

  15. Mook WR, Klement MR, Green CL, Hazen KC, Garrigues GE (2015) The incidence of propionibacterium acnes in open shoulder surgery: A controlled diagnostic study. J Bone Joint Surg Am 97(12):957–963

    Article  PubMed  Google Scholar 

  16. Trampuz A, Zimmerli W (2005) Prosthetic joint infections: update in diagnosis and treatment. Swiss Med Wkly 135(17–18):243–251

    PubMed  Google Scholar 

  17. Tunney MM, Patrick S, Curran MD, Ramage G, Hanna D, Nixon JR et al (1999) Detection of prosthetic hip infection at revision arthroplasty by immunofluorescence microscopy and PCR amplification of the bacterial 16S rRNA gene. J Clin Microbiol 37(10):3281–3290

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Janz V, Wassilew GI, Kribus M, Trampuz A, Perka C (2015) Improved identification of polymicrobial infection in total knee arthroplasty through sonicate fluid cultures. Arch Orthop Trauma Surg 135(10):1453–1457

    Article  CAS  PubMed  Google Scholar 

  19. Zappe B, Graf S, Ochsner PE, Zimmerli W, Sendi P (2008) Propionibacterium spp. in prosthetic joint infections: a diagnostic challenge. Arch Orthop Trauma Surg 128(10):1039–1046

    Article  PubMed  Google Scholar 

  20. Sperling JW, Cofield RH, Torchia ME, Hanssen AD (2003) Infection after shoulder instability surgery. Clin Orthop Relat Res 414:61–64

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Septic Surgery, Center for Musculoskeletal Surgery, Charité – University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Nora Renz, Markus Scheibel & Andrej Trampuz

  2. Department of Orthopaedic Surgery, Medical University of Vienna in the General Hospital, Vienna, Austria

    Anna Rienmüller

  3. Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland

    Olivier Borens

Authors
  1. Nora Renz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Rienmüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olivier Borens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Markus Scheibel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrej Trampuz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nora Renz.

Ethics declarations

Conflict of interest

N. Renz, A. Rienmüller, O. Borens, M. Scheibel, and A. Trampuz state that there are no conflicts of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Renz, N., Rienmüller, A., Borens, O. et al. Shoulder periprosthetic joint infection caused by Propionibacterium acnes . Obere Extremität 11, 96–100 (2016). https://doi.org/10.1007/s11678-016-0363-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11678-016-0363-3

Keywords

Schlüsselwörter

Search

Navigation