Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
Roche Molecular Systems, Pleasanton, CA, USA.
J Shoulder Elbow Surg. 2018 Jun;27(6):1097-1104. doi: 10.1016/j.jse.2017.12.025. Epub 2018 Feb 19.
Hemolysis has been suggested as a feature conferring increased pathogenicity to certain Propionibacterium acnes strains in the setting of shoulder infection. The purpose of this study was to compare the virulence of hemolytic and nonhemolytic P acnes strains in patients undergoing revision shoulder arthroplasty.
Thirty-nine patients with at least 1 positive culture growth for P acnes at the time of revision surgery were identified with P acnes isolates available for hemolysis testing. Patients were grouped into those with P acnes isolates positive (n = 20) and negative (n = 19) for hemolysis. The groups were retrospectively compared based on objective perioperative findings around the time of revision surgery and the postoperative clinical course, including the need for revision surgery. All cases were classified into categories of infection (definite infection, probable infection, and probable contaminant) based on objective perioperative criteria.
The presence of hemolysis was not significantly associated with an increased likelihood of infection (P = .968). Hemolysis demonstrated a 75% sensitivity and 26% specificity for determining infection (definite infection and probable infection categories). The hemolytic and nonhemolytic groups showed no difference regarding preoperative serum erythrocyte sedimentation rate and/or C-reactive protein level (P = .70), number of positive cultures (P = .395), time to positive culture (P = .302), and presence of positive frozen section findings (P = .501). Postoperatively, clindamycin resistance, shoulder function, and the rate of reoperation were not significantly different between the hemolytic and nonhemolytic groups.
The presence of hemolysis was not associated with increased pathogenicity in patients with P acnes-positive cultures following revision shoulder arthroplasty, when assessed by objective perioperative criteria and the postoperative clinical course.
在肩部感染的情况下，溶血已被认为是某些痤疮丙酸杆菌菌株增加致病性的特征。本研究的目的是比较接受肩关节翻修术的患者中溶血和非溶血痤疮丙酸杆菌菌株的毒力。
在翻修手术时，从至少有 1 个痤疮丙酸杆菌阳性培养物的 39 名患者中鉴定出痤疮丙酸杆菌分离株，可用于溶血试验。根据是否存在溶血将患者分为痤疮丙酸杆菌分离株阳性（n = 20）和阴性（n = 19）组。回顾性比较两组在翻修手术前后的客观围手术期发现以及术后临床过程，包括是否需要翻修手术。所有病例均根据客观围手术期标准分为感染类别（明确感染、可能感染和可能污染）。
溶血的存在与感染的可能性增加无显著相关性（P =.968）。溶血对确定感染（明确感染和可能感染类别）的敏感性为 75%，特异性为 26%。在术前红细胞沉降率和/或 C 反应蛋白水平（P =.70）、阳性培养物数量（P =.395）、阳性培养物出现时间（P =.302）和冷冻切片阳性发现的存在（P =.501）方面，溶血组和非溶血组之间无差异。术后，克林霉素耐药、肩部功能和再次手术率在溶血组和非溶血组之间无显著差异。
在肩关节翻修术后痤疮丙酸杆菌阳性培养患者中，通过客观围手术期标准和术后临床过程评估，溶血的存在与致病性增加无关。
