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Propionibacterium acnes and Orthopedic Infection

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George Cibulas

on 21 July 2014

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Transcript of Propionibacterium acnes and Orthopedic Infection

Contaminated culture or true infection?
Background
Total shoulder arthroplasty (TSA) is an effective treatment modality for glenohumeral osteoarthritis.
As rates of primary TSA increase, so does the number of revision procedures for periprosthetic infection.
Patients with subacute or delayed infections are difficult to diagnose.
Design
Retrospective review
September 2010-March 2012
Microbiology laboratory saved all clinical strains of P acnes identified regardless of source.
Retrospectively reviewed records of all orthopedic patients with positive P acnes cultures included in the database
All strains were from consecutive orthopedic pts who had + cultures and had undergone arthroplasty (n=10) or nonarthroplasty (n=12) upper extremity procedures.
Proprionibacterium acnes
Gram + bacillus
Non-spore forming
Anaerobe with aerotolerant properties
Conclusion and Discussion
Patients with cultures containing a hemolytic strain of P acnes may present with slightly higher preoperative laboratory values; These cultures likely represent a true infection.
Hemolytic phenotype 100% specific and 72% sensitive for identifying true infection from contaminated culture.
Clinically, it is very easy to obtain hemolysis status, which may prove useful to clinicians.
Results
22 P acnes strains identified
13 hemolytic
9 nonhemolytic
Mean CRP level was higher (16 mg/mL; p=.03) in the hemolytic group than in the nonhemolytic group (7.9 mg/mL)
George A. Cibulas II, MS4
University of Tennessee Health Science Center
July 21, 2014
American Journal of Orthopedics
May 2014
State University of New York- Dept of Orthopaedics
Traditionally characterized as a laboratory or handling contaminant.
Thought to be nonpathogenic as it is one of the most abundant organisms found on routine skin cultures around the shoulder.
Design
Hemolysis was determined according to P acnes growth on brucella blood agar plates after 48-72 hrs
Each patient record corresponding to the obtained P acnes strain was retrospectively reviewed for clinical data.
Orthopedic surgeon inolved in the care of the patients, but blinded to hemolytic status of the bacteria, classified infections as definite, likely, or unlikely.
Conclusion and Discussion
Limitations
Lack of intraoperative histology findings.
Partial preoperative data on 3 patients
Small size
Compared with patients with nonhemolytic strains of P acnes, patients with hemolytic strains were more likely to have definite infections with the organism, based on clinical course, and to present with significantly higher preoperative CRP levels
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