University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK.
The Arm Clinic at Wilmslow Hospital, Wilmslow, UK.
J Shoulder Elbow Surg. 2017 Sep;26(9):1553-1561. doi: 10.1016/j.jse.2017.01.008. Epub 2017 Mar 27.
Recent studies have identified the diagnostic challenge of low-grade infections after shoulder arthroplasty surgery. Infections after nonarthroplasty procedures have not been reported. This study assessed patient-related risk factors, outcomes, and clinical presentation of low-grade infection after open and arthroscopic nonarthroplasty shoulder surgery.
The cases of 35 patients presenting with suspected low-grade infection were reviewed. Biopsy specimens taken at revision surgery were cultured in the sterile environment of a class II laminar flow cabinet and incubated for a minimum of 14 days at a specialist orthopedic microbiology laboratory. Patient-related factors (age, occupation, injection), index surgery, and infection characteristics (onset of symptoms, duration to diagnosis, treatment) were analyzed.
Positive cultures were identified in 21 cases (60.0%), of which 15 were male patients (71%). Of all patients with low-grade infection, 47.6% were male patients between 16 and 35 years of age. Propionibacterium acnes and coagulase-negative staphylococcus were the most common organisms isolated (81.1% [n = 17] and 23.8% [n = 5], respectively). Of 14 negative culture cases, 9 were treated with early empirical antibiotics (64.3%); 7 patients reported symptomatic improvement (77.8%). Of 5 patients treated with late empirical antibiotics, 4 stated improvement. Patients presented with symptoms akin to resistant postoperative frozen shoulder (persistent pain and stiffness, unresponsive to usual treatments).
Young male patients are at greatest risk for low-grade infections after arthroscopic and open nonarthroplasty shoulder surgery. P. acnes was the most prevalent organism. Patients presented with classic postoperative frozen shoulder symptoms, resistant to usual treatments. Interestingly, 78.6% of patients with negative cultures responded positively to empirical treatment.
最近的研究已经确定了肩关节置换术后低度感染的诊断挑战。非关节置换手术后的感染尚未报道。本研究评估了开放式和关节镜下非关节置换肩关节手术后低度感染的患者相关危险因素、结局和临床表现。
对 35 例疑似低度感染的患者进行了回顾。在二级层流柜的无菌环境中对翻修手术时采集的活检标本进行培养，并在专门的骨科微生物学实验室中至少孵育 14 天。分析了患者相关因素（年龄、职业、注射）、指数手术和感染特征（症状发作、诊断至治疗的时间、治疗）。
21 例（60.0%）培养阳性，其中 15 例为男性（71%）。所有低度感染患者中，47.6%为 16 至 35 岁的男性患者。最常见的分离物为痤疮丙酸杆菌和凝固酶阴性葡萄球菌（81.1%[n=17]和 23.8%[n=5]）。在 14 例阴性培养病例中，9 例接受了早期经验性抗生素治疗（64.3%）；7 例患者（77.8%）报告症状改善。5 例接受晚期经验性抗生素治疗的患者中，4 例表示有改善。患者出现类似于术后冻结肩的持续性疼痛和僵硬（对常规治疗无反应）的症状。
年轻男性患者在接受关节镜和开放式非关节置换肩关节手术后低度感染的风险最高。痤疮丙酸杆菌是最常见的病原体。患者表现出典型的术后冻结肩症状，对常规治疗无反应。有趣的是，78.6%的阴性培养患者对经验性治疗有积极反应。
