Propionibacterium acnes as a cause of shoulder osteoarthritis after three shoulder arthroscopies: a case report and review of preventive action

Batarabadja Bakriga, Emmanuel Beaudouin, Noufanangue Kombate, Gamal Ayouba, Yanick Dellanh, Atchi Walla, Anani Abalo, Assang Dossim


We report a case of postoperative osteoarthritis infection caused by P. acnes after shoulder arthroscopy, and review possible preventive action. A right-handed 24-year-old man presented an anterior instability of the left shoulder. The patient underwent an anterior stabilization by the latarjet procedure. Stabilization failed, requiring a second and third surgery. The patient returned 10 months later for suspected septic arthritis of his left shoulder. An arthroscopy lavage with bacteriological and anatomo-pathological sampling was carried out. The bacteriological results revealed a positive P. acnes culture. The patient was treated using antibiotherapy for 12 weeks with a combination of clindamicin and moxifloxacin. C-reactive protein (CRP) was negative two months after the onset of antibiotherapy.  P. acnes is a anaerobic, non-sporulated, gram-positive bacillus. This commensal germ is part of the normal cutaneous flora and causes acne, but has also been recognized as a causative pathogen in osteoarticular infections since the 1990s, as described by Coden. Treatment is achieved via surgical debridement and intravenous antibiotics. We insist on preventive action in the form of a preoperative patient preparation protocol. Previous literature has underlined the important role of chlorhexidine or alcoholic iodinated polyvidone in the prevention of these infections. As P. acnes is a commensal germ of the patient's skin, prophylaxis should be reinforced by the thorough preparation of the surgery and surgical site. Clindamycin antibioprophylaxy specific to this germ should be administered for this surgery. To my knowledge, there is no specific antibioprophylaxy for shoulder surgery to date.


Proprionibacterium acnes, Arthroscopy, Shoulder, Osteoarthritis, Togo

Full Text:



Bauer T, Boisrenoult P, Jenny JY. Post-arthroscopy septic arthritis: Current data and practical recommendations. Orthop Traumatol Surg Res OTSR. 2015;101(8):347-50.

Millett PJ, Yen Y-M, Price CS, Horan MP, Meijden OA van der, Elser F. Propionobacter acnes Infection as an Occult Cause of Postoperative Shoulder Pain: A Case Series. Clin Orthop Relat Res. 2011;469(10):2824‑30.

Pottinger P, Butler-Wu S, Neradilek MB, Merritt A, Bertelsen A, Jette JL, et al. Prognostic Factors for Bacterial Cultures Positive for Propionibacterium acnes and Other Organisms in a Large Series of Revision Shoulder Arthroplasties Performed for Stiffness, Pain, or Loosening. J Bone Joint Surg Am. 2012;94(22):2075-83.

McGinley KJ, Webster GF, Leyden JJ. Regional variations of cutaneous propionibacteria. Appl Environ Microbiol. 1978;35(1):62‑6.

Söderquist B, Holmberg A, Unemo M. Propionibacterium acnes as an etiological agent of arthroplastic and osteosynthetic infections-two cases with specific clinical presentation including formation of draining fistulae. Anaerobe. 2010;16(3):304‑6.

Achermann Y, Vogt M, Leunig M, Wüst J, Trampuz A. Improved Diagnosis of Periprosthetic Joint Infection by Multiplex PCR of Sonication Fluid from Removed Implants. J Clin Microbiol. 2010;48(4):1208‑14.

Coden DJ, Hornblass A. Propionibacterium acnes Orbital Abscess. Arch Ophthalmol. 1990;108(4):481‑481.

Patel A, Calfee RP, Plante M, Fischer SA, Green A. Propionibacterium acnes colonization of the human shoulder. J Shoulder Elbow Surg. 2009;18(6):897‑902.

Berthelot P, Carricajo A, Aubert G, Akhavan H, Gazielly D, Lucht F. Outbreak of postoperative shoulder arthritis due to Propionibacterium acnes infection in nondebilitated patients. Infect Control Hosp Epidemiol. 2006;27(9):987‑90.

Chuang MJ, Jancosko JJ, Mendoza V, Nottage WM. The Incidence of Propionibacterium acnes in Shoulder Arthroscopy. Arthroscopy. 2015;31(9):1702‑7.

Singh JA, Sperling JW, Schleck C, Harmsen WS, Cofield RH. Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. J Shoulder Elbow Surg. 2012;21(11):1534‑41.

Singh JA, Sperling JW, Schleck C, Harmsen W, Cofield RH. Peri-prosthetic Infections after Shoulder Hemiarthroplasty. J Shoulder Elbow Surg. 2012;21(10):1304‑9.

Athwal GS, Sperling JW, Rispoli DM, Cofield RH. Acute deep infection after surgical fixation of proximal humeral fractures. J Shoulder Elbow Surg. 2007;16(4):408‑12.

Herrera MF, Bauer G, Reynolds F, Wilk RM, Bigliani LU, Levine WN. Infection after mini-open rotator cuff repair. J Shoulder Elbow Surg. 2002;11(6):605‑8.

Sperling JW, Cofield RH, Torchia ME, Hanssen AD. Infection after shoulder instability surgery. Clin Orthop. 2003;414:61‑4.

Marecek GS, Saltzman MD. Complications in Shoulder Arthroscopy. Orthopedics. 2010;33(7):492‑7.

Athwal GS, Sperling JW, Rispoli DM, Cofield RH. Deep infection after rotator cuff repair. J Shoulder Elbow Surg. 2007;16(3):306‑11.

Haidar R, Najjar M, Boghossian AD, Tabbarah Z. Propionibacterium acnes causing delayed postoperative spine infection: Review. Scand J Infect Dis. 2010;42(6‑7):405‑11.

Dodson CC, Craig EV, Cordasco FA, Dines DM, Dines JS, Dicarlo E, et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg. 2010;19(2):303‑7.

Sabetta JR, Rana VP, Vadasdi KB, Greene RT, Cunningham JG, Miller SR, et al. Efficacy of topical benzoyl peroxide on the reduction of Propionibacterium acnes during shoulder surgery. J Shoulder Elbow Surg. 2015;24(7):995‑1004.

Murray MR, Saltzman MD, Gryzlo SM, Terry MA, Woodward CC, Nuber GW. Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery. J Shoulder Elbow Surg. 2011;20(6):928‑33.

Société française d’anesthésie et de réanimation. Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes). Actualisation 2010. Ann Fr Anesth Réanimation. 2011;30(2):168‑90.

Levy O, Iyer S, Atoun E, Peter N, Hous N, Cash D, et al. Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis? J Shoulder Elbow Surg. 2013;22(4):505‑11.

Falk-Brynhildsen K, Friberg Ö, Söderquist B, Nilsson UG. Bacterial Colonization of the Skin Following Aseptic Preoperative Preparation and Impact of the Use of Plastic Adhesive Drapes. Biol Res Nurs. 2012;15(2):242‑8.