Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
J Shoulder Elbow Surg. 2024 Nov;33(11):2400-2410. doi: 10.1016/j.jse.2024.02.039. Epub 2024 Apr 10.
Cutibacterium acnes is the bacterium most commonly responsible for shoulder periprosthetic joint infection (PJI) and is often cultured from samples obtained at the time of revision for failed shoulder arthroplasty. We sought to determine whether these bacteria originate from the patient or from exogenous sources. We also sought to identify which C. acnes genetic traits were associated with the development of shoulder PJI.
We performed bacterial whole-genome sequencing of C. acnes from a single-institution repository of cultures obtained before or during primary and revision shoulder arthroplasty and correlated the molecular epidemiology and genetic content of strains with clinical features of infection.
A total of 341 isolates collected over a 4-year period from 88 patients were sequenced. C. acnes cultured from surgical specimens demonstrated significant similarity to the strains colonizing the skin of the same patient (P < .001). Infrequently, there was evidence of strains shared across unrelated patients, suggesting that exogenous sources of C. acnes culture-positivity were uncommon. Phylotypes IB and II were modestly associated with clinical features of PJI, but all phylotypes appeared inherently capable of causing disease. Chronic shoulder PJI was associated with the absence of common C. acnes genes involved in bacterial quorum-sensing (luxS, tqsA).
C. acnes strains cultured from deep intraoperative sources during revision shoulder arthroplasty demonstrate strong genetic similarity to the strains colonizing a patient's skin. Some phylotypes of C. acnes commonly colonizing human skin are modestly more virulent than others, but all phylotypes have a capacity for PJI. C. acnes cultured from cases of PJI commonly demonstrated genetic hallmarks associated with adaptation from acute to chronic phases of infection. This is the strongest evidence to date supporting the role of the patient's own, cutaneous C. acnes strains in the pathogenesis of shoulder arthroplasty infection. Our findings support the importance of further research focused on perioperative decolonization and management of endogenous bacteria that are likely to be introduced into the arthroplasty wound at the time of skin incision.
痤疮丙酸杆菌是导致肩部人工关节周围感染（PJI）的最常见细菌，通常从翻修失败的肩部人工关节置换术时获得的样本中培养出来。我们试图确定这些细菌是来自患者还是来自外源性来源。我们还试图确定哪些痤疮丙酸杆菌遗传特征与肩部 PJI 的发展有关。
我们对一家机构的培养物中痤疮丙酸杆菌进行了全基因组测序，这些培养物是在初次和翻修肩部人工关节置换术前或术中获得的，并将菌株的分子流行病学和遗传特征与感染的临床特征相关联。
在 4 年期间，从 88 名患者中采集了 341 个分离株进行测序。从手术标本中培养的痤疮丙酸杆菌与同一患者皮肤定植的菌株具有显著的相似性（P<0.001）。很少有证据表明存在不同患者之间共享的菌株，这表明外源性痤疮丙酸杆菌培养阳性的来源并不常见。IB 和 II 型表型与 PJI 的临床特征有一定的相关性，但所有表型似乎都具有内在的致病能力。慢性肩部 PJI 与缺乏常见的痤疮丙酸杆菌细菌群体感应（luxS、tqsA）相关基因有关。
在翻修肩部人工关节置换术中从深部手术源中培养的痤疮丙酸杆菌菌株与定植在患者皮肤的菌株具有很强的遗传相似性。一些常见定植于人类皮肤的痤疮丙酸杆菌表型比其他表型略具有更强的毒力，但所有表型都具有 PJI 的能力。从 PJI 病例中培养的痤疮丙酸杆菌通常表现出与从急性到慢性感染阶段的适应相关的遗传特征。这是迄今为止支持患者自身皮肤痤疮丙酸杆菌菌株在肩部人工关节置换感染发病机制中起作用的最强证据。我们的研究结果支持进一步研究的重要性，重点是围手术期去定植和管理可能在皮肤切口时引入关节置换伤口的内源性细菌。
