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Cutibacterium acnes is the most common bacterium in shoulder prosthetic joint infections. C. acnes is a gram-positive bacillus (Figure C).Shoulder prosthetic joint infections are serious complications of shoulder arthroplasty and a major cause for revision within the first 2 years. Diagnosis is multifaceted and involves a high index of suspicion given the indolent nature of the most common organism Cutibacterium acnes. Elevated inflammatory markers, radiographic changes around the prosthesis, and aspiration results can all assist with diagnosis. Treatment generally involves prolonged IV antibiotics and two-stage revision arthroplasty.Qui et al. reviewed the likely sources of C. acnes infections within the shoulder. They reported the presence of a low-abundance microbiome in the rotator cuff and, potentially, in other shoulder tissues. They concluded that the absence of C. acnes DNA in all shoulder tissues assessed other than the skin is consistent with the hypothesis that C. acnes infections are derived from skin contamination during surgery and not from opportunistic expansion of a resident C. acnes population in the shoulder joint.Pruijn et al. reviewed the incidence of C. acnes infections. They reported that the incidence of C. acnes infections was 43% in patients with artificial material and 42% in patients without artificial material. They concluded that younger age and lower BMI are risk factors.Pottinger et al. reviewed 193 shoulder arthroplasty revisions that were performed because of pain, loosening, or stiffness with the results of a C. acnes-specific culture protocol. They reported that preoperative and intraoperative factors can be used to help predict the risk of a positive culture for C. acnes. They concluded that prosthesis removal or retention and the need for immediate antibiotic therapy at the time of revision shoulder arthroplasty are often needed.Figure A depicts gram-positive cocci. Figure B depicts gram-negative cocci. Figure C depicts gram-positive bacilli. Figure D depicts gram-negative bacilli. Figure E depicts spirochetes as seen with light microscopy.Incorrect Answers:Answer 1: This depicts gram-positive cocci (ie Staphylococcus aureus).Answer 2: This depicts gram-negative cocci.Answer 4: This depicts gram-negative bacilli.Answer 5: This depicts spirochetes.
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