C acnes; Infection; gender; revision; shoulder surgery; Humans; Male; Female; Middle Aged; Retrospective Studies; Sex Factors; Postoperative Complications; Staphylococcus epidermidis; Propionibacterium acnes; Shoulder/microbiology; Shoulder Joint/surgery; Shoulder Joint/microbiology; Case Series; Level IV; Treatment Study; Shoulder; Shoulder Joint; Surgery; Orthopedics and Sports Medicine; General Medicine
Abstract :
[en] [en] BACKGROUND: Contrary to lower limb infection, POstoperative Shoulder surgery Infection (POSI) often involves Cutibacterium acnes. Our aim was to describe patient characteristics and pathogens retrieved in POSI to guide initial empiric antibiotic selection with suspected infection during revision. We also compared microorganisms in infection following trauma, arthroplasty (AP), and arthroscopy (AS).
METHODS: A multicenter retrospective study from 2010 to 2016 reviewed laboratory databases and medical records to identify patients with a previous shoulder surgery and a confirmed shoulder infection. The following procedures were included: AP, AS, fracture fixation (FF), and another open surgery (OS). A confirmed shoulder infection was defined as 2 positive cultures or more of the same microorganism, or clear clinical infection with 1 positive culture or more.
RESULTS: Among the 5 hospitals and 28 surgeons involved, 94 POSI cases were identified. Mean age was 59 years at index surgery (range: 22-91) with a majority of men (n = 70, 74%). Among POSI cases, AP was the most common index surgery (n = 41), followed by FF (n = 27), AS (n = 16), and OS (n = 10). The median time between index surgery and the first positive sample was 5 months and the mean was 23 months (minimum 6 days to maximum 27 years), illustrating a positively skewed distribution. Cutibacterium spp were identified in 64 patients (68%), including 59 C acnes patients (63%), which was the most frequent germ in all 4 surgical groups. In 86% of cases, C acnes was identified at the first revision. The other 2 most common germs were Staphylococcus epidermidis and Staphylococcus aureus, with 29% and 17%, respectively. Polymicrobial infection was present in 30% of patients. Gender analysis revealed that C acnes was twice as frequent in men (male = 52 of 70, female = 7 of 24; P < .001). S epidermidis was more prevalent in women (n = 11; 46%) compared with men (n = 16; 21%) (P = .032). C acnes infection was most frequent in arthroscopic surgery (n = 14; 70%, P = .049). S epidermidis was 3 times more prevalent in chronic than in acute cases.
CONCLUSION: Empiric antimicrobial therapy following POSI, while waiting for culture results, should cover C acnes, S epidermidis, and S aureus. There is a significant gender difference regarding POSI culture results. C acnes is more frequent in men, but should still be covered in women as it was found in 29% of cases.
Disciplines :
Immunology & infectious disease Orthopedics, rehabilitation & sports medicine
Author, co-author :
Orban, Catherine ; Centre Hospitalier Universitaire de Liège - CHU > > Service des maladies infectieuses - médecine interne
Goetti, Patrick; Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
Leduc, Jean-Michel ; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
Sandman, Emilie; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
Pelet, Stéphane ; CHU de Québec-Hôpital de l'Enfant-Jésus, Quebec, Quebec, Canada
Rouleau, Dominique M; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada. Electronic address: dominique.rouleau@umontreal.ca
Language :
English
Title :
The POSI study: gender differences in 94 cases of postoperative shoulder surgery infection: results of a 7-year retrospective multicenter study.
Jean-Michel Leduc received a research grant from Biomérieux , unrelated to the present work.Conflicts of interest: Frédéric Balg received departmental funding to the institution (CHU Sherbrooke) for educational and research purposes from DePuy Synthes, Wright Medical, and Zimmer Biomet.Jean-Michel Leduc received a research grant from Biomérieux, unrelated to the present work.Departmental funding to the institution (HSCM) for educational and research purposes for the authors was received from Arthrex, ConMed, DePuy, Linvatec, Smith & Nephew, Stryker, Synthes, Tornier, Wright, and Zimmer Biomet.
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