{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:56:57Z","timestamp":1788519417808,"version":"build-2803163510"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2018,2,16]],"date-time":"2018-02-16T00:00:00Z","timestamp":1518739200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS OA"],"published-print":{"date-parts":[[2018,3,29]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Propionibacterium species are commonly cultured from specimens harvested at the time of revision shoulder arthroplasty. These bacteria reside in normal sebaceous glands, out of reach of surgical skin preparation. The arthroplasty incision transects these structures, which allows Propionibacterium to inoculate the wound and to potentially lead to the formation of a biofilm on the inserted implant. To help identify patients who are at increased risk for wound inoculation, we investigated whether preoperative cultures of the specimens from the unprepared skin surface were predictive of the results of intraoperative cultures of dermal wound-edge specimens obtained immediately after incision of the surgically prepared skin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Sixty-six patients (mean age, 66.1 \u00b1 9.4 years [range, 37 to 82 years]; 73% male) undergoing primary shoulder arthroplasty had preoperative cultures of the unprepared skin surface and intraoperative cultures of the freshly incised dermis using special culture swabs. For the first 50 patients, a control swab was opened to air during the same time that the dermal specimen was obtained. The results for female and male patients were characterized as the Specimen Propionibacterium Value (SpPV). We then determined the degree to which the results of cultures of the skin surface specimens were predictive of the results of culture of the dermal specimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The skin-surface SpPV was \u22651 in 3 (17%) of the 18 female patients and 34 (71%) of the 48 male patients (p &lt; 0.001). The dermal SpPV was \u22651 in 0 (0%) of the 18 female patients and 19 (40%) of the 48 male patients (p &lt; 0.001). None of the control samples had an SpPV of \u22651. The predictive characteristics of a skin-surface SpPV of \u22651 for a dermal SpPV of \u22651 were as follows: sensitivity, 1.00 (95% confidence interval [CI], 0.82 to 1.00); specificity, 0.62 (95% CI, 0.46 to 0.75); positive predictive value, 0.51 (95% CI, 0.34 to 0.68); and negative predictive value, 1.00 (95% CI, 0.88 to 1.00).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A preoperative culture of the unprepared skin surface can help to predict whether the freshly incised dermal edge is likely to be positive for Propionibacterium. This test may help to identify patients who may merit more aggressive topical and systemic antibiotic prophylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>This study shows that surgeons have the opportunity to use preoperative skin cultures to determine the likelihood that the shoulder arthroplasty wound will be culture-positive for Propionibacterium.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.17.00052","type":"journal-article","created":{"date-parts":[[2018,2,16]],"date-time":"2018-02-16T01:29:19Z","timestamp":1518744559000},"page":"e0052","source":"Crossref","is-referenced-by-count":30,"title":["Preoperative Skin-Surface Cultures Can Help to Predict the Presence of Propionibacterium in Shoulder Arthroplasty Wounds"],"prefix":"10.2106","volume":"3","author":[{"given":"Ian","family":"MacNiven","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason E.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moni B.","family":"Neradilek","sequence":"additional","affiliation":[{"name":"The Mountain-Whisper-Light Statistics, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6465-4826","authenticated-orcid":false,"given":"Frederick A.","family":"Matsen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,2,16]]},"reference":[{"issue":"22","key":"R1-20230714","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.2106\/JBJS.K.00861","article-title":"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","volume":"94","author":"Pottinger","year":"2012","journal-title":"J Bone Joint Surg Am."},{"issue":"24","key":"R2-20230714","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.2106\/JBJS.16.00149","article-title":"Single-stage revision is effective for failed shoulder arthroplasty with positive cultures for Propionibacterium","volume":"98","author":"Hsu","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"R3-20230714","doi-asserted-by":"crossref","first-page":"597","DOI":"10.2106\/JBJS.15.00568","article-title":"Propionibacterium in shoulder arthroplasty: what we think we know today","volume":"98","author":"Hsu","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"11","key":"R4-20230714","doi-asserted-by":"crossref","first-page":"4422","DOI":"10.1099\/ijsem.0.001367","article-title":"The natural history of cutaneous Propionibacteria, and reclassification of selected species within the genus Propionibacterium to the proposed novel genera Acidipropionibacterium gen. nov., Cutibacterium gen. nov. and Pseudopropionibacterium gen. nov","volume":"66","author":"Scholz","year":"2016","journal-title":"Int J Syst Evol Microbiol."},{"issue":"20","key":"R5-20230714","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.2106\/JBJS.15.01133","article-title":"Contamination of the surgical field with Propionibacterium acnes in primary shoulder arthroplasty","volume":"98","author":"Falconer","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"23","key":"R6-20230714","doi-asserted-by":"crossref","first-page":"e1811","DOI":"10.2106\/JBJS.L.01733","article-title":"Origin of Propionibacterium in surgical wounds and evidence-based approach for culturing Propionibacterium from surgical sites","volume":"95","author":"Matsen","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"R7-20230714","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s00264-017-3421-6","article-title":"What is a \u201cperiprosthetic shoulder infection\u201d? A systematic review of two decades of publications","volume":"41","author":"Hsu","year":"2017","journal-title":"Int Orthop"},{"issue":"17","key":"R8-20230714","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.2106\/JBJS.M.01474","article-title":"Propionibacterium persists in the skin despite standard surgical preparation","volume":"96","author":"Lee","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"R9-20230714","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.jse.2014.10.016","article-title":"Propionibacterium can be isolated from deep cultures obtained at primary arthroplasty despite intravenous antimicrobial prophylaxis","volume":"24","author":"Matsen","year":"2015","journal-title":"J Shoulder Elbow Surg"},{"issue":"9","key":"R10-20230714","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.jse.2017.06.039","article-title":"Preoperative doxycycline does not decolonize Propionibacterium acnes from the skin of the 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Propionibacterium load in revision shoulder arthroplasty: a study of 137 culture-positive cases","volume":"99","author":"Ahsan","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"R14-20230714","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"Firth","year":"1993","journal-title":"Biometrika"},{"issue":"7","key":"R15-20230714","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/j.jse.2017.03.003","article-title":"Benzoyl peroxide and clindamycin topical skin preparation decreases Propionibacterium acnes colonization in shoulder arthroscopy","volume":"26","author":"Dizay","year":"2017","journal-title":"J Shoulder Elbow Surg"},{"issue":"8","key":"R16-20230714","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.2106\/JBJS.H.00768","article-title":"Efficacy of surgical preparation solutions in shoulder 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pain","volume":"24","author":"Horneff","year":"2015","journal-title":"J Shoulder Elbow Surg"},{"issue":"24","key":"R20-20230714","doi-asserted-by":"crossref","first-page":"2249","DOI":"10.2106\/JBJS.J.01994","article-title":"Increasing incidence of shoulder arthroplasty in the United States","volume":"93","author":"Kim","year":"2011","journal-title":"J Bone Joint Surg Am."}],"container-title":["JBJS Open 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