Shoulder Infection, Propionibacterium Acne - Everything You Need To Know - Dr. Nabil Ebraheim

Video Description

Educational video describing shoulder infection Propionibacterium Acnes.
Propionibacterium acnes are slow growing anaerobic gram positive bacteria. They can be rod shaped or branched usually found in the skin pores. Propionibacterium acnes may colonize in the axilla especially in males. There is difficulty in obtaining positive cultures from standard labs. Propionibacterium acnes are generally nonpathogenic but can cause numbers of infection as acne vulgaris. One of its species (p. freudenreichii) is used in swiss cheese which produces flavor and special holes in the cheese.
The Propionibacterium acne infection is the most common cause of rotator cuff infection. It is the most common organism isolated. Allow up to 14 days for the culture to grow and identify this organism. Ask the lab to hold the culture even longer if you strongly suspect infection. This organism colonizes the shoulder at an increased rate. Mini open cuff repair after arthroscopic surgery may have increased risk of infection. A second prep and drape of the surgical field may be necessary to reduce the infection. Positive cultures were found also in revision shoulder arthroplasty.
Staphylococcus epidermidis loves the prosthesis of the hip and knee. P-acne however, loves prosthesis in the shoulder. P-acne is skin bacteria responsible for shoulder infection and it is usually subtle subclinical presentation. The clinical presentation is insidious and nonspecific. The traditional signs of infection are usually lacking: fever, erythema, severe pain, blood work not consistently elevated. It is a slow growing bacteria and the culture takes from 1 week to 3 weeks to become positive. It creates a diagnostic challenge. The initial culture is negative. The lab does not usually hold the cultures for a long time unless instructed. If you suspect infection, ask the lab to hold the culture for at least 2 weeks. Men have a higher bacterial burden than women. P-acne is a common cause of indolent infection and shoulder implant failure. Infection of the shoulder with P-acne should be considered as a cause of persistent unexplained shoulder pain.
Treatment
•Obtain fluid from aspiration or obtain a tissue sample(multiple tissue samples are better)
•Keep the culture for about 2 weeks
•Debridement
•IV antibiotics (resistance to antibiotics is a challenge)
•May need removal of the prosthesis.
In summary, the Propionibacterium acne infection is an emerging clinical entity. It's harm goes beyond the skin and should not be considered a contaminant. It is becoming an orthopedic pathogen and not just a dermatology pathogen. It is probably resistant to the standard broad spectrum antibiotics. The clinician should be aware that this bacteria loves to infect the shoulder. Case example of a patient with pain in the shoulder that was found to be infected with P-acne.

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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step