Cutibacterium acnes Infections in Shoulder Arthroplasty, a Need for New Guidelines: a Scoping Review

Prosthetic joint infections (PJIs) account for up to 18% of shoulder arthroplasty complications. The most common pathogen in periprosthetic joint infections following shoulder arthroplasty is Cutibacterium acnes . C. acnes colonizes the sebaceous glands located in the dermis, the density of which is more abundant in the shoulder region. The aim of this scoping review is to analyze the impact of C. acnes in shoulder prosthetic surgery to outline whether there is a need for new guidelines in this complex scenario. A single search of Medline, PubMed, and Embase was completed in September 2021. Studies were eligible for inclusion if they included data on risk factors, diagnosis, management, or prophylaxis of Cutibacterium acnes periprosthetic infections. Study designs eligible for inclusion were systematic reviews, scoping reviews, narrative reviews, randomized controlled trials, cohort studies, case–control studies, and case series of shoulder PJIs. Case reports, expert opinions, letters to editor, unpublished literature of trials databases, and studies not written in English were excluded. A narrative synthesis of risk factors, clinical presentation, diagnostic investigations, therapeutic approaches, and prophylactic measures was undertaken. Risk factors for C. acnes periprosthetic infections include male gender, young age, shoulder surgery, increased duration of the surgery, and first surgery of the day. Post-traumatic shoulder arthroplasty, reverse total arthroplasty, and revision arthroplasty appear to carry significantly higher infection risk. As for diagnosis, tissue culture remains the gold standard diagnostic test. However, a prolonged incubation period appears to be required to detect C. acnes periprosthetic infections. Clindamycin and vancomycin are the most used antibiotics to treat C. acnes periprosthetic infections; still up to date, no consensus guidelines on how to manage C. acnes PJIs exist. Moreover, resistance to clindamycin is emerging. Cefazolin is commonly used as prophylactic antibiotic in orthopedic surgery, but it is not effective in eradicating C. acnes . There is still an observable lack of consensus guidelines on strategies for prevention, diagnosis, and treatment of postoperative shoulder infections. Most preventative measures described in medical literature lack a level of evidence to provide proof of their efficacy, highlighting the need for research and new guidelines to better address antibiotic regimens to prevent C. acnes PJI in shoulder surgery.