Nachweis von Cutibacterium in der Schulterchirurgie
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Zusammenfassung
Hintergrund
Die Anzahl an schulterchirurgischen Operationen ist in den letzten Jahren deutlich gestiegen. Mit zunehmenden diagnostischen Möglichkeiten, chronische periprothetische Infektionen zu detektieren, ist die Inzidenz der Cutibacterium-Infektion (früher Proprionibacterium) in der Schulterchirurgie gestiegen.
Fragestellung
Diese Arbeit beschäftigt sich mit Diagnostik, Inzidenz und therapeutischer Konsequenz der Cutibacterium-Infektion in der Schulterchirurgie mit dem Ziel, langwierige und kostenträchtige Krankheitsverläufe nach schulterchirurgischen Eingriffen zu vermeiden.
Ergebnisse
Verschiedene Studien identifizierten Cutibacterium als den häufigsten pathogenen Keim bei periprothetischen Schulterinfektionen. Jedoch sollte bedacht werden, dass der Nachweis des Cutibacterium im Schulterbereich auch ohne klinische Zeichen einer Infektion vorliegen kann und nicht immer eine sofortige therapeutische Konsequenz gezogen werden muss. Die aktuellen Richtlinien zur Therapie beinhalten eine Implantatentfernung sowie eine antimikrobielle Therapie für 12 Wochen.
Schlussfolgerung
Es sollte ein größeres Bewusstsein über die Inzidenz von Cutibacterium-Infektionen in der Schulterchirurgie herrschen. Die Evidenz der aktuellen Therapieempfehlung sollte durch weitere prospektive, randomisierte, kontrollierte Studien geprüft werden.
Schlüsselwörter
Proprionibacterium Low-grade-Infektion Endoprotheseninfekt Implantatentfernung Antimikrobielle TherapieDetection of Cutibacterium in shoulder surgery
Abstract
Background
The number of shoulder surgeries has significantly increased in recent years. With improved diagnostic modalities to detect chronic periprosthetic infections, the incidence of Cutibacterium infections (formerly Proprionibacterium) in shoulder surgery has increased.
Objective
In this article the diagnostics, incidence and therapeutic consequences of Cutibacterium infections in shoulder surgery are discussed with the aim to avoid protracted and costly disease courses after surgical interventions of the shoulder.
Results
Various studies have identified Cutibacterium as the most frequently occurring pathogen in periprosthetic shoulder infections; however, it should be taken into consideration that Cutibacterium can be detected in the shoulder area without any signs of clinical infection. Detection of Cutibacterium does not always necessitate immediate therapeutic consequences; however, the current treatment guidelines include the removal of the implant and antimicrobial therapy over 12 weeks.
Conclusion
There should be a greater awareness of the incidence of Cutibacterium infections in shoulder surgery. Prospective, randomized, controlled studies are needed to confirm evidence for the current treatment recommendations.
Keywords
Proprionibacterium Low-grade infection Endoprosthetic joint infection Implant removal Antimicrobial treatmentNotes
Einhaltung ethischer Richtlinien
Interessenkonflikt
J.F. Schader, R. Hudek, A. Trampuz und M. Scheibel geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Literatur
- 1.Achermann Y, Goldstein EJ, Coenye T et al (2014) Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev 27:419–440CrossRefGoogle Scholar
- 2.Both A, Klatte TO, Lubke A et al (2018) Growth of cutibacterium acnes is common on osteosynthesis material of the shoulder in patients without signs of infection. Acta Orthop 89:580–584CrossRefGoogle Scholar
- 3.Chuang MJ, Jancosko JJ, Mendoza V et al (2015) The incidence of propionibacterium acnes in shoulder arthroscopy. Arthroscopy 31:1702–1707CrossRefGoogle Scholar
- 4.Crane JK, Hohman DW, Nodzo SR et al (2013) Antimicrobial susceptibility of propionibacterium acnes isolates from shoulder surgery. Antimicrob Agents Chemother 57:3424–3426CrossRefGoogle Scholar
- 5.Furustrand Tafin U, Corvec S, Betrisey B et al (2012) Role of rifampin against propionibacterium acnes biofilm in vitro and in an experimental foreign-body infection model. Antimicrob Agents Chemother 56:1885–1891CrossRefGoogle Scholar
- 6.Garrigues GE, Zmistowski B, Cooper AM et al (2019) Proceedings from the 2018 international consensus meeting on orthopedic infections: management of periprosthetic shoulder infection. J Shoulder Elbow Surg 28:S67–S99CrossRefGoogle Scholar
- 7.Horneff JG 3rd, Hsu JE, Voleti PB et al (2015) Propionibacterium acnes infection in shoulder arthroscopy patients with postoperative pain. J Shoulder Elbow Surg 24:838–843CrossRefGoogle Scholar
- 8.Hudek R, Sommer F, Kerwat M et al (2014) Propionibacterium acnes in shoulder surgery: true infection, contamination, or commensal of the deep tissue? J Shoulder Elbow Surg 23:1763–1771CrossRefGoogle Scholar
- 9.Janz V, Wassilew GI, Hasart O et al (2013) Evaluation of sonicate fluid cultures in comparison to histological analysis of the periprosthetic membrane for the detection of periprosthetic joint infection. Int Orthop 37:931–936CrossRefGoogle Scholar
- 10.Koh CK, Marsh JP, Drinkovic D et al (2016) Propionibacterium acnes in primary shoulder arthroplasty: rates of colonization, patient risk factors, and efficacy of perioperative prophylaxis. J Shoulder Elbow Surg 25:846–852CrossRefGoogle Scholar
- 11.Levy O, Iyer S, Atoun E et al (2013) Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis? J Shoulder Elbow Surg 22:505–511CrossRefGoogle Scholar
- 12.Levy PY, Fenollar F, Stein A et al (2008) Propionibacterium acnes postoperative shoulder arthritis: an emerging clinical entity. Clin Infect Dis 46:1884–1886CrossRefGoogle Scholar
- 13.Maccioni CB, Woodbridge AB, Balestro JC et al (2015) Low rate of propionibacterium acnes in arthritic shoulders undergoing primary total shoulder replacement surgery using a strict specimen collection technique. J Shoulder Elbow Surg 24:1206–1211CrossRefGoogle Scholar
- 14.Marin M, Garcia-Lechuz JM, Alonso P et al (2012) Role of universal 16S rRNA gene PCR and sequencing in diagnosis of prosthetic joint infection. J Clin Microbiol 50:583–589CrossRefGoogle Scholar
- 15.Millett PJ, Yen YM, Price CS et al (2011) Propionibacterium acnes infection as an occult cause of postoperative shoulder pain: a case series. Clin Orthop Relat Res 469:2824–2830CrossRefGoogle Scholar
- 16.Mook WR, Klement MR, Green CL et al (2015) The incidence of propionibacterium acnes in open shoulder surgery: a controlled diagnostic study. J Bone Joint Surg Am 97:957–963CrossRefGoogle Scholar
- 17.Namdari S, Nicholson T, Abboud J et al (2019) Comparative study of cultures and next-generation sequencing in the diagnosis of shoulder prosthetic joint infections. J Shoulder Elbow Surg 28:1–8CrossRefGoogle Scholar
- 18.Oprica C, Nord CE, ESCMID Study Group on Antimicrobial Resistance in Anaerobic Bacteria (2005) European surveillance study on the antibiotic susceptibility of propionibacterium acnes. Clin Microbiol Infect 11:204–213CrossRefGoogle Scholar
- 19.Osmon DR, Berbari EF, Berendt AR et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:e1–e25CrossRefGoogle Scholar
- 20.Persico F, Lorenz E, Seligson D (2014) Complications of operative treatment of clavicle fractures in a level I trauma center. Eur J Orthop Surg Traumatol 24:839–844CrossRefGoogle Scholar
- 21.Portillo ME, Corvec S, Borens O et al (2013) Propionibacterium acnes: an underestimated pathogen in implant-associated infections. Biomed Res Int 2013:804391CrossRefGoogle Scholar
- 22.Portillo ME, Salvado M, Alier A et al (2014) Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection. J Infect 69:35–41CrossRefGoogle Scholar
- 23.Renz N, Cabric S, Janz V et al (2015) Sonication in the diagnosis of periprosthetic infections: significance and practical implementation. Orthopäde 44:942–945CrossRefGoogle Scholar
- 24.Renz N, Mudrovcic S, Perka C et al (2018) Orthopedic implant-associated infections caused by cutibacterium spp.—a remaining diagnostic challenge. PLoS ONE 13:e202639CrossRefGoogle Scholar
- 25.Singh JA, Sperling JW, Schleck C et al (2012) Periprosthetic infections after shoulder hemiarthroplasty. J Shoulder Elbow Surg 21:1304–1309CrossRefGoogle Scholar
- 26.Torrens C, Mari R, Alier A et al (2019) Cutibacterium acnes in primary reverse shoulder arthroplasty: from skin to deep layers. J Shoulder Elbow Surg 28:839–846CrossRefGoogle Scholar
- 27.Trampuz A, Osmon DR, Hanssen AD et al (2003) Molecular and antibiofilm approaches to prosthetic joint infection. Clin Orthop Relat Res 414:69–88CrossRefGoogle Scholar
- 28.Trampuz A, Piper KE, Jacobson MJ et al (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663CrossRefGoogle Scholar
- 29.Wong JC, Schoch BS, Lee BK et al (2018) Culture positivity in primary total shoulder arthroplasty. J Shoulder Elbow Surg 27:1422–1428CrossRefGoogle Scholar
- 30.Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654CrossRefGoogle Scholar
- 31.Pro-Implant Foundation Webpräsenz. http://www.pro-implant-foundation.org/. Zugegriffen: 21. Okt. 2019Google Scholar