Complications Associated With Intravenous Antibiotic Treatment for <i>Cutibacterium acnes</i> Periprosthetic Shoulder Infection.

Abstract

Whether positive <i>Cutibacterium acnes</i> cultures during revision shoulder arthroplasty represent true periprosthetic joint infection (PJI), deep tissue inoculant, or laboratory contaminant is a point of substantial controversy. The purpose of this study was to review complications of intravenous antibiotics used for treatment of presumed <i>C acnes</i> shoulder PJI. A study population of 26 patients treated for <i>C acnes</i> PJI with a minimum follow-up of 2 years after operative treatment was established. Complication occurrence and severity were obtained through chart review and phone survey. Sixteen (61.5%) patients experienced a therapeutic complication. Twelve (46.2%) patients experienced a total of 47 antibiotic-associated adverse effects and 10 (38.5%) patients experienced 11 total peripherally inserted central catheter line-associated complications. Female sex carried an increased risk for severe complications (relative risk, 3.3; 95% CI, 1.2-9.5; <i>P</i>=.024). Treatment duration of greater than 6 weeks was a significant predictor for the total number of complications experienced [<i>F</i>(1,23)=5.361; <i>P</i>=.030; adjusted <i>R</i>²=0.189]. Age older than 65 years, treatment duration greater than 6 weeks, and female sex were significant predictors for the number of severe complications [<i>F</i>(3,21)=3.249; <i>P</i>=.042; adjusted <i>R</i>²=0.219]. Treating <i>C acnes</i> infection with intravenous antibiotics carries a substantial risk of adverse events, highlighting the importance of accurate diagnosis of shoulder PJI. Further investigations into the efficacy and safety profile of oral antibiotics for shoulder PJI are necessary. [<i>Orthopedics</i>. 2021;44(3):e422-e426.].