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Journal of Shoulder and Elbow Surgery Oct 2022Unexpected positive cultures (UPCs) are very commonly found during shoulder arthroplasty when surgeons send intraoperative cultures to rule out periprosthetic joint... (Review)
Review
BACKGROUND
Unexpected positive cultures (UPCs) are very commonly found during shoulder arthroplasty when surgeons send intraoperative cultures to rule out periprosthetic joint infection (PJI) without clinical or radiographic signs of infection. Cutibacterium acnes is thought to be the most common bacteria cultured in this setting; however, the implications of an unexpected positive result are neither well defined nor agreed upon within the literature. The current review evaluates the incidence of UPCs and C acnes in reverse total arthroplasty; the clinical significance, if any, of these cultures; and various prognostic factors that may affect UPC incidence or recovery following PJI.
METHODS
A systematic review was performed with PRISMA guidelines using PubMed, CINAHL, and Scopus databases. Inclusion criteria included studies published from January 1, 2000, to May 20, 2021, that specifically reported on UPCs, native or revision shoulder surgery, and any study that directly addressed one of our 6 proposed clinical questions. Two independent investigators initially screened 267 articles for further evaluation. Data on study design, UPC rate/speciation, UPC risk factors, and UPC outcomes were analyzed and described.
RESULTS
A total of 22 studies met the inclusion criteria for this study. There was a pooled rate of 27.5% (653/2373) deep UPC specimen positivity, and C acnes represented 76.4% (499/653) of these positive specimens. Inanimate specimen positivity was reported at a pooled rate of 20.1% (29/144) across 3 studies. Male patients were more likely to have a UPC; however, the significance of prior surgery, surgical approach, and type of surgery conflicted across multiple articles. Patient-reported outcomes and reoperation rates did not differ between positive-UPC and negative-UPC patients. The utilization of antibiotics and treatment regimen varied across studies; however, the reinfection rates following surgery did not statistically differ based on the inclusion of antibiotics.
CONCLUSION
UPCs are a frequent finding during shoulder surgery and C acnes represents the highest percentage of cultured bacteria. Various preoperative risk factors, surgical techniques, and postoperative treatment regimens did not significantly affect the incidence of UPCs as well as the clinical outcomes for UPC vs. non-UPC patients. A standardized protocol for treatment and follow-up would decrease physician uncertainty when faced with a UPC from shoulder surgery. Given the results of this review, shoulder surgeons can consider not drastically altering the postoperative clinical course in the setting of UPC with no other evidence of PJI.
Topics: Anti-Bacterial Agents; Arthritis, Infectious; Arthroplasty; Arthroplasty, Replacement, Shoulder; Bacteria; Humans; Male; Propionibacterium acnes; Prosthesis-Related Infections; Reoperation; Shoulder Joint
PubMed: 35513254
DOI: 10.1016/j.jse.2022.03.019 -
International Journal of Dermatology Mar 2024Antibiotics have constituted the mainstay of acne therapy despite acne being classified as an inflammatory disorder. The indiscriminate usage of antibiotics over the... (Review)
Review
Antibiotics have constituted the mainstay of acne therapy despite acne being classified as an inflammatory disorder. The indiscriminate usage of antibiotics over the years has thus fueled the issue of antimicrobial resistance. Cutibacterium acnes (C. acnes) can acquire resistance due to chromosomal mutation or genetic acquisition. C. acnes can transfer resistance to other resident flora, complicating the management of skin and soft tissue infections. It can also transfer resistant strains to other body sites and to immunocompromised and elderly patients thus putting them at risk of serious infections. Recent studies have highlighted the physiologic role of C. acnes in maintaining the normal homeostasis of the skin microbiome. The role of Malassezia in causation of acne has piqued interest in recent times. The efficacy of antibiotics in acne is attributed to their para-antibiotic, anti-inflammatory action rather than antimicrobial action. Thus, usage of low-dose antibiotics and alternatives to antibiotics has been advocated. Some alternative therapies showing efficacy in acne are probiotics, oral zinc, precision therapy using succinic acid, bacteriophages, and anti-biofilm therapy like myrtacin, topical azelaic acid, and salicylic acid. Using isotretinoin in early stages of acne can reduce the incidence of scarring and alleviate the need for antibiotics. Thus, a gradual shift from antibiotics to alternative therapies in acne is the need of the hour.
Topics: Humans; Aged; Anti-Bacterial Agents; Acne Vulgaris; Isotretinoin; Skin; Salicylic Acid; Propionibacterium acnes
PubMed: 37743606
DOI: 10.1111/ijd.16854 -
Indian Journal of Dermatology 2023The study of antimicrobial-resistant was not conducted regularly, especially in Indonesia. Conversely, regular monitoring of antibiotic efficacy through testing to...
The study of antimicrobial-resistant was not conducted regularly, especially in Indonesia. Conversely, regular monitoring of antibiotic efficacy through testing to assess the evolution of current resistance patterns is obligated; thus, filling the gap caused by a lack of appropriate antibiotic surveillance is required. Analyse the correlation between resistance patterns of to doxycycline, clindamycin, erythromycin and azithromycin with the severity of acne vulgaris. This is an analytic observational laboratory study with a cross-sectional design of mild to severe acne vulgaris (AV) patients. Specimens were obtained from comedones of 71 patients, which were cultured and identified using biochemical examination. Antimicrobial resistance (doxycycline, clindamycin, erythromycin and azithromycin) to was tested by disc diffusion method. Among 71 samples collected, 40 (56.3%) isolates were cultured and identified. The incidence of resistance to more than one antimicrobial was 45%. Antimicrobial resistances were clindamycin 42.5%, erythromycin 40%, azithromycin 23.5% and doxycycline 12.5%, respectively. According to the contingency coefficient test, there was moderate correlation between the resistance pattern of to clindamycin ( = 0.485, = <0.001) and doxycycline ( = 0.433, = 0.002) and AV severity. There was weak correlation between the resistance pattern of to erythromycin ( = 0.333; = 0.025) and azithromycin ( = 0.321; = 0.032) and AV severity. In conclusion, there is a correlation between the pattern of resistance to doxycycline, clindamycin, erythromycin, azithromycin and severity of AV.
PubMed: 37822407
DOI: 10.4103/ijd.ijd_623_22 -
The Journal of the American Academy of... Nov 2019The use of shoulder arthroplasty is continuing to expand. Periprosthetic joint infection of the shoulder is a devastating complication occurring in approximately 1% of... (Review)
Review
The use of shoulder arthroplasty is continuing to expand. Periprosthetic joint infection of the shoulder is a devastating complication occurring in approximately 1% of cases. The most common organisms responsible for the infection are Cutibacterium acnes (formerly Propionibacterium acnes) (∼39%) and coagulase-negative Staphylococcus (∼29%). Evaluation of patients includes history and physical examination, serologic testing, imaging, possible joint aspiration, and tissue culture. Diagnosing infections caused by lower virulence organisms (eg, C acnes) poses a challenge to the surgeon because traditional diagnostic tests (erythrocyte sedimentation rate, C-reactive protein, and joint aspiration) have a low sensitivity due to the lack of an inflammatory response. Periprosthetic joint infections of the shoulder due to Staphylococcus aureus and other highly virulent organisms are often easy to diagnose and are usually treated with two-stage revisions. However, for infections with C acnes and coagulase-negative Staphylococcus, single- and two-stage revision surgeries have shown similar ability to clear the infection. Unexpected positive cultures for C acnes during revision surgery are not uncommon; the proper management is still under investigation and remains a challenge.
Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Shoulder; Combined Modality Therapy; Debridement; Humans; Propionibacterium acnes; Prosthesis-Related Infections; Reoperation; Salvage Therapy; Shoulder Joint; Staphylococcus aureus
PubMed: 31008878
DOI: 10.5435/JAAOS-D-18-00232 -
European Journal of Dermatology : EJD Feb 2021Acne vulgaris is a common pilosebaceous disease associated with Propionibacterium acnes (P. acnes). Resolution of comedones may occur in association with shrunken...
BACKGROUND
Acne vulgaris is a common pilosebaceous disease associated with Propionibacterium acnes (P. acnes). Resolution of comedones may occur in association with shrunken sebaceous glands (SGs) containing de-differentiated cells, however the role of P. acnes is unclear.
OBJECTIVES
To investigate the effects of P. acnes on aryl hydrocarbon receptor (AhR) activation, lipogenesis and differentiation in cultured immortalized human SZ95 sebocytes.
MATERIALS & METHODS
Cultured sebocytes were incubated with formalin-killed (f-) P. acnes (f-P. acnes) at different ratios of multiplicity of infection. The mRNA levels of the AhR downstream cytochrome P450 (CYP) genes were measured by quantitative RT-PCR, nuclear translocation of AhR by western blot and immunofluorescence, lipogenesis and keratinization by gene set enrichment analysis (GSEA), lipid related analysis by Oil red O staining and Nile red staining, and sebaceous differentiation-related gene expression by western blot.
RESULTS
f-P. acnes upregulated CYPs mRNA levels and induced translocation of AhR protein from the cytoplasm into the nucleus. GSEA revealed downregulation of lipogenesis and upregulation of keratinization. f-P. acnes inhibited linoleic acid-induced neutral lipid synthesis and expression of sebocyte markers, keratin 7 and mucin1/EMA, but increased expression of keratinocyte markers, keratin 10 and involucrin, which were abolished by AhR gene silencing. Inhibition of lipogenesis-related genes, such as sterol response element-binding protein, was also observed.
CONCLUSION
f-P. acnes inhibits lipogenesis and induces terminal differentiation of sebocytes, into keratinocyte-like cells, via activation of the AhR pathway in vitro, suggesting that follicular P. acnes is not only acnegenic but also promotes acne remission through feedback regulation of sebum production.
Topics: Cell Differentiation; Cells, Cultured; Formaldehyde; Humans; Propionibacterium acnes; Receptors, Aryl Hydrocarbon; Sebaceous Glands
PubMed: 33648912
DOI: 10.1684/ejd.2021.3964 -
International Journal of Biological... 2022Acne vulgaris is a common skin disease, affecting over 80% of adolescents. Inflammation is known to play a central role in acne development. Here, we aimed to...
Acne vulgaris is a common skin disease, affecting over 80% of adolescents. Inflammation is known to play a central role in acne development. Here, we aimed to investigate the role of the central clock gene in acne-associated inflammation in mice. To this end, mice were injected intradermally with () to induce acne-associated skin inflammation. We found that and its target genes and were down-regulated in the skin of -treated mice, suggesting a role of in the condition of acne. Supporting this, -deleted or jet-lagged mice showed exacerbated -induced inflammation in the skin. Regulation of -induced inflammation by was further confirmed in RAW264.7 cells and primary mouse keratinocytes. Transcriptomic and protein expression analyses suggested that regulated -induced inflammation via the NF-κB/NLRP3 axis, which is known to be repressed by REV-ERBα (a direct target of BMAL1). Moreover, loss of in mice exacerbated -induced inflammation. In addition, silencing attenuated the inhibitory effects of on -induced inflammation. knockdown failed to modulate -induced inflammation in -silenced cells. It was thus proposed that restrained -induced skin inflammation via its target REV-ERBα, which acts on the NF-κB/NLRP3 axis to repress inflammation. In conclusion, disruption is identified as a potential pathological factor of acne-associated inflammation. The findings increase our understanding of the crosstalk between skin clock and acne and suggest targeting circadian rhythms as a promising approach for management of acne.
Topics: ARNTL Transcription Factors; Acne Vulgaris; Animals; Inflammation; Mice; NF-kappa B; NLR Family, Pyrin Domain-Containing 3 Protein; Nuclear Receptor Subfamily 1, Group D, Member 1; Propionibacterium acnes
PubMed: 35414779
DOI: 10.7150/ijbs.71719 -
European Journal of Orthopaedic Surgery... Feb 2023Cutibacterium Acnes (C.acnes) has been linked to several shoulder pathologies. An alternative hypothesis suggests it only occurs in the joint secondary to previous...
BACKGROUND
Cutibacterium Acnes (C.acnes) has been linked to several shoulder pathologies. An alternative hypothesis suggests it only occurs in the joint secondary to previous instrumentation. Our hypothesis was patients with previous instrumentation would have C.acnes in their joint if it was in skin.
MATERIALS AND METHODS
Sixty-six patients undergoing arthroscopic shoulder surgery had biopsies taken from the affected joint at the time of surgery, along with control biopsies of subdermal fat. The extended culture results were assessed and correlated to previous intervention.
RESULTS
35% tested positive for C.acnes in their joint. 78% were male. 53% had absence of C.acnes in both skin and joint and 29% had presence in both (p = 0.0001). 15% with previous surgery had C.acnes. 53% with previous injection had C.acnes. 25% of patients with virgin joints had C.acnes. There was no statistical difference in the presence of C.acnes in the joint between those with previous instrumentation and without.
CONCLUSION
The significant factors for joint C.acnes were male sex and the presence of the bacteria in the fat. Previous instrumentation was not correlated with C.acnes in the joint. This raises the question of whether the process of biopsy itself may lead to inoculation of the joint.
Topics: Humans; Male; Female; Shoulder Joint; Gram-Positive Bacterial Infections; Shoulder; Skin; Propionibacterium acnes
PubMed: 35031853
DOI: 10.1007/s00590-021-03186-8 -
Journal of the European Academy of... Jan 2021Antibiotic resistance in acne was first observed in the 1970s and has been a major concern in dermatology since the 1980s. The resistance rates and types of... (Review)
Review
Antibiotic resistance in acne was first observed in the 1970s and has been a major concern in dermatology since the 1980s. The resistance rates and types of antimicrobials have subsequently shown great variations in regions and countries. Illustrative of this is the resistance to topical erythromycin and clindamycin which continues to be a problem worldwide, while resistance to systemic treatment with tetracyclines has remained low during the past decade. The resistance for the newer macrolides like azithromycin and clarithromycin has been increasing. The results of antibiotic resistance may include treatment failure of acne, disturbance of skin microbiota, induction of opportunistic pathogens locally and systemically, and dissemination of resistant strains to both healthcare personnel and the general population. The ensuing complications, such as aggravated opportunistic infections caused by Propionibacterium acnes and the emergence of multiresistant superbugs, have not yet been confirmed.
Topics: Acne Vulgaris; Anti-Bacterial Agents; Clindamycin; Drug Resistance, Bacterial; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Propionibacterium acnes
PubMed: 32474948
DOI: 10.1111/jdv.16686 -
Letters in Applied Microbiology Dec 2021Propionibacterium acnes plays a major role in acne vulgaris. In the pre-experiment, the growth of P. acnes was inhibited effectively using surfactin; however, the...
Propionibacterium acnes plays a major role in acne vulgaris. In the pre-experiment, the growth of P. acnes was inhibited effectively using surfactin; however, the antibacterial mechanism has not been described. Therefore, the aim of this study was to evaluate antibacterial activity and analyse the mechanism of surfactin against P. acnes. Minimum inhibitory concentration, time-killing kinetics and scanning electron microscopy were used to evaluate the activity of surfactin against P. acnes, which showed that 128 μg ml effectively inhibited growth. Cell wall permeability was evaluated by detecting the extracellular alkaline phosphatase activity, which increased to 1·83- and 2·32-fold after incubating with 128 and 256 μg ml of surfactin for 10 h, respectively. Propidium iodide fluorescence, leakage of nucleic acid, protein, K , and Ca , membrane potential and the leakage of calcein from small unilamellar vesicles all increased after incubation with surfactin, indicating that its strong biological activities act mainly by altering membrane integrity. In a mouse model of acne, surfactin significantly reduced P. acnes-induced epidermal swelling and erythema. These results indicate that surfactin effectively inhibited the growth of P. acnes by destroying the cell wall and membrane, and is a potential candidate for acne treatment.
Topics: Acne Vulgaris; Animals; Anti-Bacterial Agents; Cell Wall; Mice; Microbial Sensitivity Tests; Propionibacterium acnes
PubMed: 34607389
DOI: 10.1111/lam.13576 -
Phytomedicine : International Journal... Jan 2021Celastrol, a pentacyclic triterpenoid quinonemethide isolated from several spp. of Celastraceae family, exhibits anti-inflammatory activities in a variety of diseases...
BACKGROUND
Celastrol, a pentacyclic triterpenoid quinonemethide isolated from several spp. of Celastraceae family, exhibits anti-inflammatory activities in a variety of diseases including arthritis.
PURPOSE
This study aims to investigate whether the inhibition of NLRP3 inflammasome is engaged in the anti-inflammatory activities of celastrol and delineate the underlying mechanism.
METHODS
The influence of celastrol on NLRP3 inflammasome activation was firstly studied in lipopolysaccharide (LPS)-primed mouse bone marrow-derived macrophages (BMDMs) and phorbol 12-myristate 13-acetate (PMA)-primed THP-1 cells treated with nigericin. Reconstituted inflammasome was also established by co-transfecting NLRP3, ASC, pro-caspase-1 and pro-IL-1β in HEK293T cells. The changes of inflammasome components including NLRP3, ASC, pro-caspase-1/caspase-1 and pro-IL-1β/IL-1β were examined by enzyme-linked immunosorbent assay (ELISA), western blotting and immunofluorescence. Furthermore, Propionibacterium acnes (P. acnes)/LPS-induced liver injury and monosodium urate (MSU)-induced gouty arthritis in mice were employed in vivo to validate the inhibitory effect of celastrol on NLRP3 inflammasome.
RESULTS
Celastrol significantly suppressed the cleavage of pro-caspase-1 and pro-IL-1β, while not affecting the protein expressions of NLRP3, ASC, pro-caspase-1 and pro-IL-1β in THP-1 cells, BMDMs and HEK293T cells. Celastrol suppressed NLRP3 inflammasome activation and alleviated P. acnes/LPS-induced liver damage and MSU-induced gouty arthritis. Mechanism study revealed that celastrol could interdict K63 deubiquitination of NLRP3, which may concern interaction of celastrol and BRCA1/BRCA2-containing complex subunit 3 (BRCC3), and thereby prohibited the formation of NLRP3, ASC and pro-caspase-1 complex to block the generation of mature IL-1β.
CONCLUSION
Celastrol suppresses NLRP3 inflammasome activation in P. acnes/LPS-induced liver damage and MSU-induced gouty arthritis via inhibiting K63 deubiquitination of NLRP3, which presents a novel insight into inhibition of celastrol on NLRP3 inflammasome and provides more evidences for its application in the therapy of inflammation-related diseases.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; HEK293 Cells; Humans; Inflammasomes; Lipopolysaccharides; Liver; Lysine; Macrophages; Male; Mice, Inbred C57BL; Mice, Mutant Strains; NLR Family, Pyrin Domain-Containing 3 Protein; Pentacyclic Triterpenes; Propionibacterium acnes; THP-1 Cells; Triterpenes; Ubiquitination; Uric Acid; Mice
PubMed: 33130474
DOI: 10.1016/j.phymed.2020.153398