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Are Cutibacterium acnes delivered from skin to deep tissues in primary reverse shoulder arthroplasty? A prospective study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The objective of this study is to determine whether the deep tissues are inoculated during surgery with the Cutibacterium acnes still present in the skin after the surgical preparation in reverse shoulder arthroplasties.

Materials and methods

Prospective study including patients undergoing surgery with reverse shoulder arthroplasty. All the patients received preoperative antibiotic prophylaxis with cefazolin (2 g IV) and the skin was prepared with 2% chlorhexidine gluconate and 70% isopropyl alcohol. From all the patients, 9 cultures were obtained after the antibiotic was administrated and the skin surgically prepared. The cultures were sent to isolate C. acnes. DNA was extracted from the C. acnes isolated colonies. Isolate nucleotide distances were calculated using the Genome-based distance matrix calculator from the Enveomics collection toolbox.

Results

The study included 90 patients. C. acnes was isolated in 24 patients (26.6%) with a total of 61 positive cultures. There were 12 phylotype II, 27 IB and 22 IA. In 9 patients, C. acnes was present in both skin and deep tissues, and they constituted the sample to be studied by means of genomic analysis. In 7 out of the 9 patients, deep tissue samples clustered closer to at least one of its corresponding skin isolates when compared to the other independent bacterial ones.

Conclusions

The C. acnes present in the skin at the beginning of the surgery are the same as those found in the deep tissues at the end of the surgery. This result strengthens the possibility that the C. acnes is delivered from the skin to the deep tissues.

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Acknowledgements

The authors wish to thank Xavier Duran Jordà, MStat, PhD (Methodology and Biostatistics Support Unit, Institute Hospital del Mar for Medical Research (IMIM), Barcelona, Spain) for his work in data analysis.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain

    Carlos Torrens, Fernando Santana & Albert Alier

  2. Pathology Department, Hospital del Mar, Barcelona, Spain

    Beatriz Bellosillo & Joan Gibert

  3. Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain

    Beatriz Bellosillo & Joan Gibert

  4. Microbiology Service, Laboratori de Referència de Catalunya, Hospital del Mar, Barcelona, Spain

    Amaya Suárez-López

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [CT], [BB], [JG], [AS-L], [FS], [AA]. The first draft of the manuscript was written by [CT] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Carlos Torrens.

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The authors have no relevant financial or non-financial interests to disclose.

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The study was approved by the ethical committee with number (2020/9141/I). (CEIC-Parc de Salut Mar).

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Torrens, C., Bellosillo, B., Gibert, J. et al. Are Cutibacterium acnes delivered from skin to deep tissues in primary reverse shoulder arthroplasty? A prospective study. Arch Orthop Trauma Surg 144, 635–640 (2024). https://doi.org/10.1007/s00402-023-05125-0

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