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Frederick A. Matsen – One of the best experts on this subject based on the ideXlab platform.

  • preoperative skin cultures are predictive of Propionibacterium load in deep cultures obtained at revision shoulder arthroplasty
    Journal of Shoulder and Elbow Surgery, 2018
    Co-Authors: Jason E Hsu, Stacy M. Russ, Moni B Neradilek, Frederick A. Matsen
    Abstract:

    Background 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 artharthroplasty in patients without clinical evidence of infection. Methods The study enrolled 60 patients undergoing revision for a prior shoulder artharthroplasty 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. Results 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). Conclusions 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.

  • Propionibacterium in shoulder arthroplasty what we think we know today
    Journal of Bone and Joint Surgery American Volume, 2016
    Co-Authors: Jason E Hsu, Roger E. Bumgarner, Frederick A. Matsen
    Abstract:

    Propionibacterium is a slow-growing gram-positive rod that is part of the normal skin microbiome but can be found on culture of specimens from a large number of patients having revision shoulder artharthroplasty performed for pain, stiffness, and component loosening. ➤ Propionibacterium infections do not present with obvious signs of infection, such as swelling, erythema, drainage, or tenderness, but rather are of the so-called stealth type, presenting with unexplained pain, stiffness, or component loosening months to years after the index arthroplasty. ➤ Not all propionibacteria are the same: certain subtypes of Propionibacterium are enriched with virulence factors that may enhance deep infection. ➤ Because propionibacteria typically reside in the pilosebaceous glands of the oily skin of the chest and back, standard surgical skin preparation solutions and even perioperative intravenous antibiotics are often inadequate at sterilizing the incision site; therefore, other prophylactic measures such as meticulous implant handling to avoid contact with dermal structures need to be considered. ➤ Recovery of Propionibacterium from the surgical wounds requires that multiple specimens for culture be taken from different areas of the shoulder to reduce sampling error, and cultures should be held for two weeks on multiple culture media. ➤ Future research efforts can be focused on reducing the risk of implant infection and point-of-care methods for identifying Propionibacterium infections.

  • Propionibacterium can be isolated from deep cultures obtained at primary arthroplasty despite intravenous antimicrobial prophylaxis
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Frederick A. Matsen, Stacy M. Russ, Alexander Bertelsen, Susan M Butlerwu, Paul S. Pottinger
    Abstract:

    Background Propionibacterium organisms are commonly recovered from deep cultures obtained at the time of revision artharthroplasty. This study sought to determine whether deep cultures obtained at the time of primary arthroplasty can be substantially positive for Propionibacterium despite thorough skin preparation and preoperative intravenous antibiotic prophylaxis. Methods After timely administration of preoperative antibiotics chosen specifically for their activity against Propionibacterium and after double skin preparation, specimens from the dermis, fascia, capsule, synovium, and glenoid tissue were sterilely harvested from 10 male patients undergoing primary shoulder artharthroplasty and were submitted for culture for Propionibacterium . Results Of the 50 specimens, 7 were positive for Propionibacterium : 3 in each of 2 patients and 1 in 1 patient. The specimen sources having positive anaerobic cultures were the dermis (1 of 10), fascia (2 of 10), synovium (1 of 10), and glenoid tissue (3 of 10). None of these patients had evidence of infection at the time of the arthroplasty. Discussion and Conclusion Preoperative antibiotics and skin preparation do not always eliminate Propionibacterium from the surgical field of primary shoulder artharthroplasty. The presence of these bacteria in the arthroplasty wound may pose a risk of delayed shoulder artharthroplasty failure from the subtle type of periprosthetic infection typically associated with Propionibacterium .

Roger E. Bumgarner – One of the best experts on this subject based on the ideXlab platform.

  • Propionibacterium in shoulder arthroplasty what we think we know today
    Journal of Bone and Joint Surgery American Volume, 2016
    Co-Authors: Jason E Hsu, Roger E. Bumgarner, Frederick A. Matsen
    Abstract:

    Propionibacterium is a slow-growing gram-positive rod that is part of the normal skin microbiome but can be found on culture of specimens from a large number of patients having revision shoulder arthroplasty performed for pain, stiffness, and component loosening. ➤ Propionibacterium infections do not present with obvious signs of infection, such as swelling, erythema, drainage, or tenderness, but rather are of the so-called stealth type, presenting with unexplained pain, stiffness, or component loosening months to years after the index arthroplasty. ➤ Not all propionibacteria are the same: certain subtypes of Propionibacterium are enriched with virulence factors that may enhance deep infection. ➤ Because propionibacteria typically reside in the pilosebaceous glands of the oily skin of the chest and back, standard surgical skin preparation solutions and even perioperative intravenous antibiotics are often inadequate at sterilizing the incision site; therefore, other prophylactic measures such as meticulous implant handling to avoid contact with dermal structures need to be considered. ➤ Recovery of Propionibacterium from the surgical wounds requires that multiple specimens for culture be taken from different areas of the shoulder to reduce sampling error, and cultures should be held for two weeks on multiple culture media. ➤ Future research efforts can be focused on reducing the risk of implant infection and point-of-care methods for identifying Propionibacterium infections.

  • Propionibacterium persists in the skin despite standard surgical preparation.
    The Journal of bone and joint surgery. American volume, 2014
    Co-Authors: Michael J. Lee, Paul S. Pottinger, Susan M. Butler-wu, Roger E. Bumgarner, Stacy M. Russ, Frederick A. Matsen
    Abstract:

    BACKGROUND Propionibacterium acnes, which normally resides in the skin, is known to play a role in surgical site infection in orthopaedic surgery. Studies have suggested a persistence of propionibacteria on the skin surface, with rates of positive cultures ranging from 7% to 29% after surgical preparation. However, as Propionibacterium organisms normally reside in the dermal layer, these studies may underestimate the true prevalence of propionibacteria after surgical skin preparation. We hypothesized that, after surgical skin preparation, viable Propionibacterium remains in the dermis at a much higher rate than previously reported. METHODS Ten healthy male volunteers underwent skin preparation of the upper back with ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol). Two 3-mm dermal punch biopsy specimens were obtained through the prepared skin and specifically cultured for P. acnes. RESULTS Seven volunteers had positive findings for Propionibacterium on dermal cultures after ChloraPrep skin preparation. The average time to positive cultures was 6.78 days. CONCLUSIONS This study found that Propionibacterium persists in the dermal tissue even after surface skin preparation with ChloraPrep. The 70% rate of persistence of propionibacteria after skin preparation is substantially higher than previously reported. CLINICAL RELEVANCE Propionibacteria are increasingly discussed as having an association with infection, implant failure, and degenerative disease. This study confirms the possibility that the dermal layer of skin may be the source of the bacteria.

  • Origin of Propionibacterium in surgical wounds and evidence-based approach for culturing Propionibacterium from surgical sites.
    The Journal of bone and joint surgery. American volume, 2013
    Co-Authors: Frederick A. Matsen, Susan M. Butler-wu, Alexander Bertelsen, Bradley C. Carofino, Jocelyn L. Jette, Roger E. Bumgarner
    Abstract:

    Background: To explore the origin of Propionibacterium in surgical wounds and to suggest an optimized strategy for culturing this organism at the time of revision surgery, we studied the presence of this organism on the skin and in the surgical wounds of patients who underwent revision artharthroplasty for reasons other than apparent infection. Methods: Specimens were cultured in broth and on aerobic and anaerobic media. The presence and degree of positivity of Propionibacterium cultures were correlated with sex. The results of dermal and deep cultures were correlated. Times to positivity and the yields of each media type and specimen source were investigated. Results: Propionibacterium grew in twenty-three of thirty cultures of specimens obtained preoperatively from the unprepared epidermis over the area where a skin inciincision was going to be made for a shoulder artharthroplasty; males had a greater average degree of positivity than females (p < 0.002). Twelve of twenty-one male subjects and zero of twenty female subjects who had cultures of dermal specimens obtained during revision shoulder artharthroplasty had positive findings for Propionibacterium (p = 0.0001). Twelve of twenty male subjects and only one of twenty female subjects had positive deep cultures (p = 0.0004). The positivity of dermal cultures for Propionibacterium was significantly associated with the positivity of deep cultures for this organism (p = 0.0001). If Propionibacterium was present in deep tissues, it was likely that it would be recovered by culture if four different specimens were obtained and cultured for a minimum of seventeen days on three different media: aerobic, anaerobic, and broth. Conclusions: Because the surgical incision of dermal sebaceous glands may be a source of Propionibacterium in deep wounds, strategies for minimizing the risk of Propionibacterium infections may need to be directed at minimizing the contamination of surgical wounds from these bacteria residing in rather than on the skin. Obtaining at least four specimens, observing them for seventeen days, and using three types of culture media optimize the recovery of Propionibacterium at the time of revision surgery.

Paul S. Pottinger – One of the best experts on this subject based on the ideXlab platform.

  • Propionibacterium can be isolated from deep cultures obtained at primary arthroplasty despite intravenous antimicrobial prophylaxis
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Frederick A. Matsen, Stacy M. Russ, Alexander Bertelsen, Susan M Butlerwu, Paul S. Pottinger
    Abstract:

    Background Propionibacterium organisms are commonly recovered from deep cultures obtained at the time of revision arthroplasty. This study sought to determine whether deep cultures obtained at the time of primary arthroplasty can be substantially positive for Propionibacterium despite thorough skin preparation and preoperative intravenous antibiotic prophylaxis. Methods After timely administration of preoperative antibiotics chosen specifically for their activity against Propionibacterium and after double skin preparation, specimens from the dermis, fascia, capsule, synovium, and glenoid tissue were sterilely harvested from 10 male patients undergoing primary shoulder arthroplasty and were submitted for culture for Propionibacterium . Results Of the 50 specimens, 7 were positive for Propionibacterium : 3 in each of 2 patients and 1 in 1 patient. The specimen sources having positive anaerobic cultures were the dermis (1 of 10), fascia (2 of 10), synovium (1 of 10), and glenoid tissue (3 of 10). None of these patients had evidence of infection at the time of the arthroplasty. Discussion and Conclusion Preoperative antibiotics and skin preparation do not always eliminate Propionibacterium from the surgical field of primary shoulder arthroplasty. The presence of these bacteria in the arthroplasty wound may pose a risk of delayed shoulder arthroplasty failure from the subtle type of periprosthetic infection typically associated with Propionibacterium .

  • substantial cultures of Propionibacterium can be found in apparently aseptic shoulders revised three years or more after the index arthroplasty
    Journal of Shoulder and Elbow Surgery, 2015
    Co-Authors: Erik Mcgoldrick, Susan M Butlerwu, Paul S. Pottinger, Matthew D Mcelvany, Frederick A. Matsen
    Abstract:

    Background Revisions of apparently “aseptic” shoulder arthroplasties are not infrequently culture positive for Propionibacterium , organisms that may be introduced at the time of the index surgery when the dermal sebaceous glands are transected. This report seeks to answer the question, Do surgeons performing revision shoulder artharthroplasty years after the index procedure need to be concerned about the persistence of Propionibacterium ? Methods We reviewed the medical records of 148 revision arthroplasties performed between July 2008 and June 2013 to find those revisions performed at least 3 years after the index procedure and at which intraoperative cultures were strongly positive for Propionibacterium . Results We identified 14 cases of revision surgery performed 8 ± 4 years after the original arthroplasty for which deep cultures were strongly positive for Propionibacterium. A total of 109 specimens were obtained, 84 of which were positive. All 14 patients were male. Conclusion Shoulder arthroplasties revised for the mechanical problems of loosening or stiffness can be substantially culture positive for Propionibacterium , even if the revision is performed many years after the index procedure. Therefore, even in shoulder arthroplasties revised for mechanical problems years after the index procedures, surgeons should consider submitting multiple deep specimens for specific Propionibacterium culture. In the presence of persistent Propionibacterium , surgeons should consider the need for directed surgical and medical treatment in their management of a failed arthroplasty.

  • Propionibacterium persists in the skin despite standard surgical preparation.
    The Journal of bone and joint surgery. American volume, 2014
    Co-Authors: Michael J. Lee, Paul S. Pottinger, Susan M. Butler-wu, Roger E. Bumgarner, Stacy M. Russ, Frederick A. Matsen
    Abstract:

    BACKGROUND Propionibacterium acnes, which normally resides in the skin, is known to play a role in surgical site infection in orthopaedic surgery. Studies have suggested a persistence of propionibacteria on the skin surface, with rates of positive cultures ranging from 7% to 29% after surgical preparation. However, as Propionibacterium organisms normally reside in the dermal layer, these studies may underestimate the true prevalence of propionibacteria after surgical skin preparation. We hypothesized that, after surgical skin preparation, viable Propionibacterium remains in the dermis at a much higher rate than previously reported. METHODS Ten healthy male volunteers underwent skin preparation of the upper back with ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol). Two 3-mm dermal punch biopsy specimens were obtained through the prepared skin and specifically cultured for P. acnes. RESULTS Seven volunteers had positive findings for Propionibacterium on dermal cultures after ChloraPrep skin preparation. The average time to positive cultures was 6.78 days. CONCLUSIONS This study found that Propionibacterium persists in the dermal tissue even after surface skin preparation with ChloraPrep. The 70% rate of persistence of propionibacteria after skin preparation is substantially higher than previously reported. CLINICAL RELEVANCE Propionibacteria are increasingly discussed as having an association with infection, implant failure, and degenerative disease. This study confirms the possibility that the dermal layer of skin may be the source of the bacteria.

Anne Thierry – One of the best experts on this subject based on the ideXlab platform.

  • Propionibacterium spp. and AcidiPropionibacterium spp.
    , 2020
    Co-Authors: Meral Turgay, Hans-peter Bachmann, Stefan Irmler, Ueli Von Ah, Marie-therese Frö Hlich-wyder, Hélène Falentin, Stéphanie-marie Deutsch, Gwénaël Jan¨, Anne Thierry
    Abstract:

    Genomic evidence has led to the division of genus Propionibacterium into Propionibacterium and AcidiPropionibacterium. They are pleomorphic rods, anaerobic to aerotolerant, mesophilic, Gram-positive and of high G+C. They produce propionic acid as a major end product from many substrates. P. freudenreichii is used as ripening culture in Swiss-type cheeses, where it produces propionic and acetic acid, CO2 and aroma compounds leading to the characteristic flavor and eyes. They also produce vitamins and other compounds of interest and may be used as probiotics. Genetic tools and genome sequences are now available for both Propionibacterium and AcidiPropionibacterium genera, which will improve their applications.

  • great interspecies and intraspecies diversity of dairy propionibacteria in the production of cheese aroma compounds
    International Journal of Food Microbiology, 2014
    Co-Authors: Alyson L Yee, Anne Thierry, Mariebernadette Maillard, Nathalie Roland, Victoria Chuat, Aurelie Leclerc, Tomislav Pogacic, Florence Valence
    Abstract:

    Flavor is an important sensory property of fermented food products, including cheese, and largely results from the production of aroma compounds by microorganisms. Propionibacterium freudenreichii is the most widely used species of dairy propionibacteria; it has been implicated in the production of a wide variety of aroma compounds through multiple metabolic pathways and is associated with the flavor of Swiss cheese. However, the ability of other dairy propionibacteria to produce aroma compounds has not been characterized. This study sought to elucidate the effect of interspecies and intraspecies diversity of dairy propionibacteria on the production of aroma compounds in a cheese context. A total of 76 strains of Propionibacterium freudenreichii, Propionibacterium jensenii, Propionibacterium thoenii, and Propionibacterium acidipropionici were grown for 15 days in pure culture in a rich medium derived from cheese curd. In addition, one strain each of two phylogenetically related non-dairy propionibacteria, Propionibacterium cyclohexanicum and Propionibacterium microaerophilum were included. Aroma compounds were analyzed using headspace trap-gas chromatography-mass spectrometry (GC-MS). An analysis of variance performed on GC-MS data showed that the abundance of 36 out of the 45 aroma compounds detected showed significant differences between the cultures. A principal compcomponent analysis (PCA) was performed for these 36 compounds. The first two axes of the PCA, accounting for 60% of the variability between cultures, separated P. freudenreichii strains from P. acidipropionici strains and also differentiated P. freudenreichii strains from each other. P. freudenreichii strains were associated with greater concentrations of a variety of compounds, including free fattfatty acids from lipolysis, ethyl esters derived from these acids, and branched-chain acids and alcohols from amino acid catabolism. P. acidipropionici strains produced less of these compounds but more sulfur-containing compounds from methionine catabolism. Meanwhile, branched-chain aldehydes and benzaldehyde were positively associated with certain strains of P. jensenii and P. thoenii. Moreover, the production of compounds with a common origin was correlated. Compound abundance varied significantly by strain, with fold changes between strains of the same species as high as in the order of 500 for a single compound. This suggests that the diversity of dairy propionibacteria can be exploited to modulate the flavor of mild cheeses.

  • Propionibacterium ssp.
    , 2011
    Co-Authors: Anne Thierry, Hélène Falentin, Stéphanie-marie Deutsch, Gwénaël Jan¨
    Abstract:

    Propionibacterium ssp.

Jason E Hsu – One of the best experts on this subject based on the ideXlab platform.

  • preoperative skin cultures are predictive of Propionibacterium load in deep cultures obtained at revision shoulder arthroplasty
    Journal of Shoulder and Elbow Surgery, 2018
    Co-Authors: Jason E Hsu, Stacy M. Russ, Moni B Neradilek, Frederick A. Matsen
    Abstract:

    Background 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. Methods 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. Results 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). Conclusions 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.

  • Propionibacterium in shoulder arthroplasty what we think we know today
    Journal of Bone and Joint Surgery American Volume, 2016
    Co-Authors: Jason E Hsu, Roger E. Bumgarner, Frederick A. Matsen
    Abstract:

    Propionibacterium is a slow-growing gram-positive rod that is part of the normal skin microbiome but can be found on culture of specimens from a large number of patients having revision shoulder arthroplasty performed for pain, stiffness, and component loosening. ➤ Propionibacterium infections do not present with obvious signs of infection, such as swelling, erythema, drainage, or tenderness, but rather are of the so-called stealth type, presenting with unexplained pain, stiffness, or component loosening months to years after the index arthroplasty. ➤ Not all propionibacteria are the same: certain subtypes of Propionibacterium are enriched with virulence factors that may enhance deep infection. ➤ Because propionibacteria typically reside in the pilosebaceous glands of the oily skin of the chest and back, standard surgical skin preparation solutions and even perioperative intravenous antibiotics are often inadequate at sterilizing the incision site; therefore, other prophylactic measures such as meticulous implant handling to avoid contact with dermal structures need to be considered. ➤ Recovery of Propionibacterium from the surgical wounds requires that multiple specimens for culture be taken from different areas of the shoulder to reduce sampling error, and cultures should be held for two weeks on multiple culture media. ➤ Future research efforts can be focused on reducing the risk of implant infection and point-of-care methods for identifying Propionibacterium infections.