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C.acnes in the joint, is it all just a false positive?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Cutibacterium Acnes (C.acnes) has been linked to several shoulder pathologies. An alternative hypothesis suggests it only occurs in the joint secondary to previous instrumentation. Our hypothesis was patients with previous instrumentation would have C.acnes in their joint if it was in skin.

Materials and methods

Sixty-six patients undergoing arthroscopic shoulder surgery had biopsies taken from the affected joint at the time of surgery, along with control biopsies of subdermal fat. The extended culture results were assessed and correlated to previous intervention.

Results

35% tested positive for C.acnes in their joint. 78% were male. 53% had absence of C.acnes in both skin and joint and 29% had presence in both (p = 0.0001). 15% with previous surgery had C.acnes. 53% with previous injection had C.acnes. 25% of patients with virgin joints had C.acnes. There was no statistical difference in the presence of C.acnes in the joint between those with previous instrumentation and without.

Conclusion

The significant factors for joint C.acnes were male sex and the presence of the bacteria in the fat. Previous instrumentation was not correlated with C.acnes in the joint. This raises the question of whether the process of biopsy itself may lead to inoculation of the joint.

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References

  1. Hudek R, Sommer F, Abdelkawi AF, Kerwat M, Muller H-H, Gohlke F (2016) Propionibacterium acnes in shoulder surgery: is loss of hair protective for infection? J Shoulder Elbow Surg 25(6):973–980

    Article  PubMed  Google Scholar 

  2. Levy O (2013) Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis? J Shoulder Elbow Surg 22(4):505–511.

  3. Booker S, Boyd M, Gallacher S, Evans JP, Auckland C, Kitson J et al (2017) The colonisation of the glenohumeral joint by Propionibacterium acnes is not associated with frozen shoulder but is more likely to occur after an injection into the joint. Bone Joint J 99-B(8):1067–1072.

  4. Kadler BK, Mehta SS, Funk L (2015) Propionibacterium acnes infection after shoulder surgery. Int J Shoulder Surg 9(4):139–144

    Article  PubMed  PubMed Central  Google Scholar 

  5. Achermann Y, Goldstein EJ, Coenye T, Shirtliff ME (2014) Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev 27:419–440

    Article  PubMed  PubMed Central  Google Scholar 

  6. Aubin GG, Portillo ME, Trampuz A, Corvec S (2014) Propionibacterium acnes, an emerging pathogen: from acne to implant-infections, from phylotype to resistance. Med Mal Infect 44:241–250

    Article  CAS  PubMed  Google Scholar 

  7. Bunker BM, Gallacher S, Auckland CR, Kitson J, Smith CD (2014) Association between Propionibacterium acnes and frozen shoulder: a pilot study. Shoulder Elbow 6(4):257–261

    Article  PubMed  PubMed Central  Google Scholar 

  8. Alexeyev OA, Marklund I, Shannon B, Golovleva I, Olsson J, Andersson C et al (2007) Direct visualization of Propionibacterium acnes in prostate tissue by multicolor fluorescent in situ hybridization assay. J Clin Microbiol 45:3721–3728

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Cohen RJ, Shannon BA, McNeal JE, Shannon T, Garrett KL (2005) Propionibacterium acnes associated with inflammation in radical prostatectomy specimens: a possible link to cancer evolution? J Urol 173:1969–1974

    Article  PubMed  Google Scholar 

  10. Hudek R, Sommer F, Kerwat M, Abdelkawi AF, Loos F, Gohlke F (2014) Propionibacterium acnes in shoulder surgery: true infection, contamination, or commensal of the deep tissue? J shoulder elbow surg 23(12):1763–1771

    Article  PubMed  Google Scholar 

  11. Dramis A, Aldlyami E, Grimer RJ, Dunlop DJ, O’Connell N, Elliott T (2009) What is the significance of a positive Propionibacterium acnes culture around a joint replacement? Int Orthop 33:829–833

    Article  CAS  PubMed  Google Scholar 

  12. No authors listed. BSAC Methods for Antimicrobial Susceptibility Testing, Version 14, January 2015. http://bsac.org.uk/wp-content/uploads/2012/02/BSAC-disc-susceptibility-testing-method-Jan-2015.pdf (date last accessed 16 June 2021).

  13. Benson DA, Karsch-Mizrachi I, Lipman DJ, Ostell J, Wheeler DL (2008) GenBank. Nucleic Acids Res 36(Database issue):D25–D30.

  14. Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ (1990) Basic local alignment search tool. J Mol Biol 215:403–410

    Article  CAS  PubMed  Google Scholar 

  15. Kong Koh C, Marsh JP, Drinkovic D, Walker CG, Poon PC (2016) Propionibacterium acnes in primary shoulder arthroplasty: rates of colonization, patient risk factors, and efficacy of perioperative prophylaxis. J shoulder elbow surg 25(5):846–852

    Article  Google Scholar 

  16. Patel A, Calfee RP, Plante M, Fischer SA, Green A (2009) Propionibacterium acnes colonization of the human shoulder. J shoulder elbow surg 18(6):897–902

    Article  PubMed  Google Scholar 

  17. Piggott DA, Higgins YM, Melia MT, Ellis B, Carroll KC, McFarland EG et al (2016) Characteristics and Treatment outcomes of Propionibacterium acnes Prosthetic Shoulder Infections in Adults. Open Forum Infect Dis 3(1):ofv191.

  18. 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 

  19. Pochi PE, Strauss JS (1974) Endocrinologic control of the development and activity of the human sebaceous gland. J Invest Dermatol 62:191–201

    Article  CAS  PubMed  Google Scholar 

  20. Pottinger P, Butler-Wu S, Neradilek MB, Merritt A, Bertelsen A, Jette JL et al (2012) Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness pain, or loosening. J Bone joint surg Am 94(22):2075–2083

    Article  PubMed  Google Scholar 

  21. Roh M, Han M, Kim D, Chung K (2006) Sebum output as a factor contributing to the size of facial pores. Br J Dermatol 155:890–894

    Article  CAS  PubMed  Google Scholar 

  22. Kiraly CL, Alen M, Korvola J, Horsmanheimo M (1998) The effect of testosterone and anabolic steroids on the skin surface lipids and the population of propionibacteria acnes in young postpubertal men. Acta Derm Venereol 68(1):21–26

    Google Scholar 

  23. Kim H-J, Kim JJ, Myeong NR, Kim T, Kim D, An S et al (2019) Segregation of age-related skin microbiome characteristics by functionality. Sci Rep 9:16748

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shibagaki N, Suda W, Clavaud C, Bastien P (2017) Aging-related changes in the diversity of women’s skin microbiomes associated with oral bacteria. Sci Rep 7:10567

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kolakowski L, Lai JK, Duvall GT, Jauregui JJ, Dubina AG, Jones DL et al (2018) Benzoyl Peroxide effectively decreases pre-operative Cutibacterium acnes shoulder burden: a prospective randomised control trial. J Shoulder Elbow Surg 27(9):1539–1544

    Article  PubMed  Google Scholar 

  26. Levy PY, Fenollar F, Stein A, Borrione F, Cohen E, Lebail B et al (2008) Propionibacterium acnes postoperative shoulder arthritis: an emerging clinical entity. Clin Infect Dis 46:1884–1886

    Article  PubMed  Google Scholar 

  27. Grosso MJ, Sabesan VJ, Ho JC, Ricchetti ET, Iannotti JP (2012) Reinfection rates after 1-stage revision shoulder arthroplasty for patients with unexpected positive intraoperative cultures. J Shoulder Elbow Surg 21:754–758

    Article  PubMed  Google Scholar 

  28. Kelly JD, Hobgood ER (2009) Positive culture rate in revision shoulder arthroplasty. Clin Orthop Relat Res 467:2343–2348

    Article  PubMed  PubMed Central  Google Scholar 

  29. Topolski MS, Chin PY, Sperling JW, Cofield RH (2006) Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology. J Shoulder Elbow Surg 15:402–406

    Article  PubMed  Google Scholar 

  30. Achermann Y, Sahin F, Schwyzer H-K, Kolling C, Wust J, Vogt M (2013) Characteristics and outcome of 16 periprosthetic shoulder joint infections. Infection 41(3):613–620

    Article  CAS  PubMed  Google Scholar 

  31. Scheer VM, Jungestrom MB, Lerm M, Serrander L, Kalen A (2018) Topical benzoyl peroxide application on the shoulder reduces Propionibacterium acnes: a randomized study. J shoulder elbow surg 27(6):975–961

    Article  Google Scholar 

  32. Holmberg A, Lood R, Morgelin M, Holst BSE, Collin M, Christensson B et al (2009) Biofilm formation by Propionibacterium acnes is a characteristic of invasive isolates. Clin Microbiol Infect 15:787–795

    Article  CAS  PubMed  Google Scholar 

  33. Coenye T, Peeters E, Nelis HJ (2007) Biofilm formation by Propionibacterium acnes is associated with increased resistance to antimicrobial agents and increased production of putative virulence factors. Res Microbiol 158:386–392

    Article  CAS  PubMed  Google Scholar 

  34. Ramage G, Tunney MM, Patrick S, Gorman SP, Nixon JR (2003) Formation of Propionibacterium acnes biofilms on orthopaedic biomaterials and their susceptibility to antimicrobials. Biomaterials 24:3221–3227

    Article  CAS  PubMed  Google Scholar 

  35. Torrens C, Mari R, Alier A, Puig L, Santana F, Corvec S (2019) Cutibacterium acnes in primary reverse shoulder arthroplasty: from skin to deep layers. J shoulder elbow surg 28(5):839–846

    Article  PubMed  Google Scholar 

  36. Qiu B, Al K, Pena-Diaz AM, Athwal GS, Drosdowech D, Faber KJ et al (2018) Cutibacterium acnes and the shoulder microbiome. J shoulder elbow surg 27(10):1734–1739

    Article  PubMed  Google Scholar 

  37. Millett PJ, Yen Y-M, Price CS, Horan MP, van der Meijden OA, Elser F (2011) Propionibacterium acnes infection as an occult cause of postoperative shoulder pain: a case series. Clin Orthop Relat Res 469:2824–2830

    Article  PubMed  PubMed Central  Google Scholar 

  38. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ et al (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Rel Res 469:2992–2994

    Article  Google Scholar 

  39. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH et al (2010) Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am 92:2102–2109

    Article  PubMed  Google Scholar 

  40. Brook I, Frazier EH (1991) Infections caused by Propionibacterium species. Rev Infect Dis 13:819–822

    Article  CAS  PubMed  Google Scholar 

  41. Hsu JE, Neradilek MB, Russ SM (2018) Pre-operative skin cultures are predictive of Propionibacterium load in deep cultures obtained a revision shoulder arthroplasty. J Shoulder Elbow Surg 27(5):765–770

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma and Orthopaedics, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK

    Timothy J. Batten, Sian Gallacher, William J. Thomas, Jeffrey Kitson & Christopher D. Smith

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  1. Timothy J. Batten
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Correspondence to Timothy J. Batten.

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Batten, T.J., Gallacher, S., Thomas, W.J. et al. C.acnes in the joint, is it all just a false positive?. Eur J Orthop Surg Traumatol 33, 315–320 (2023). https://doi.org/10.1007/s00590-021-03186-8

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  • DOI: https://doi.org/10.1007/s00590-021-03186-8

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