Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
The Mountain-Whisper-Light Statistics, Seattle, WA, USA.
J Shoulder Elbow Surg. 2018 May;27(5):765-770. doi: 10.1016/j.jse.2018.01.021. Epub 2018 Mar 12.
Propionibacterium-specific cultures are commonly positive in revised shoulders without obvious signs of infection. To help identify patients at risk for these "stealth" presentations of positive Propionibacterium cultures, we assessed the value of a preoperative skin culture in predicting the results of deep cultures obtained at the time of revision shoulder arthroplasty in patients without clinical evidence of infection.
The study enrolled 60 patients undergoing revision for a prior shoulder arthroplasty without clinical evidence of infection. A preoperative culture of the skin surface was taken before skin preparation. At surgery, multiple (mean 5.9 ± standard deviation 1.6) deep tissue and explant cultures were harvested from the shoulder. Each culture was semiquantitatively reported as the specimen Propionibacterium value (SpPV). All SpPVs from the deep specimens from each patient were summed as the total shoulder Propionibacterium score (ShPS). The averaged ShPS was the total ShPS divided by the number of deep specimens harvested.
A multivariate analysis demonstrated that the preoperative skin SpPV was predictive of the Propionibacterium load in the revised shoulders as indicated by the total ShPS (P = .004) and averaged ShPS (P = .003).
In this series of patients, a preoperative culture of the unprepared skin was strongly predictive of the Propionibacterium load in revised shoulder arthroplasties without clinical evidence of infection. This result suggests that the results of skin cultures taken before revision surgery may help inform operative management with respect to the need for prosthesis exchange and extended postoperative antibiotic treatment.
在修订后的肩部，即使没有明显感染迹象，通常也会出现阳性的丙酸杆菌培养。为了帮助识别那些存在“隐匿性”阳性丙酸杆菌培养结果的患者，我们评估了术前皮肤培养在预测无临床感染证据的翻修肩关节炎患者在翻修时深部培养结果中的作用。
本研究纳入了 60 例因先前的肩关节炎行翻修术且无临床感染证据的患者。在皮肤准备前，取术前皮肤表面培养物。在手术中，从肩部采集多个（平均 5.9±1.6）深部组织和植入物培养物。每个培养物均按标本丙酸杆菌值（SpPV）进行半定量报告。每位患者的深部标本的所有 SpPV 相加得到总肩丙酸杆菌评分（ShPS）。平均 ShPS 是总 ShPS 除以采集的深部标本数。
多变量分析表明，术前皮肤 SpPV 可预测经修订的肩部丙酸杆菌负荷，表现为总 ShPS（P = .004）和平均 ShPS（P = .003）。
在本系列患者中，术前未准备皮肤的培养物强烈预测了无临床感染证据的翻修肩关节炎中的丙酸杆菌负荷。这一结果表明，在翻修手术前采集的皮肤培养物的结果可能有助于指导手术管理，包括是否需要更换假体和延长术后抗生素治疗。
