ASSOCIATION BETWEEN PROPRIONIBACTERIUM ACNES AND PREVIOUS SURGERY
Research type
Research Study
Full title
ASSOCIATION BETWEEN PROPRIONIBACTERIUM ACNES AND PREVIOUS SURGERY; A PILOT STUDY. A cross-sectional study into the prevalence of P. acnes in patients with a history of previous shoulder surgery.
IRAS ID
204417
Contact name
Chris Smith
Contact email
Sponsor organisation
Royal Devon and Exeter Hospital
Duration of Study in the UK
0 years, 6 months, 1 days
Research summary
Proprionibacterium acnes (P Acnes) is an aerotolerant anaerobic gram positive bacterium that is a common skin commensal found on the face, shoulders and upper trunk in particular.
It can cause skin infections such as Acne vulgaris. P Acnes is difficult to culture and its role in pathology of the shoulder has recently been questioned. It has been potentially implicated in Osteoarthritis, rotator cuff tears and frozen shoulder. The question of it being a commensal organism has also been raised.
Commensal organisms within the human body have been associated with pathology, such
as Helicobacter in peptic ulceration and Proprionibacterium acnes has been cultured from the intervertebral discs of patients with low back pain.Two preliminary studies have been completed, whereby samples were taken from 20
patients with a frozen shoulder at the time of arthroscopy to determine the prevalebnce of P. acnes and 20 patients from a control group of young patients with shoulder instability.Results from preliminary studies
Forty patients were recruited into the study. P.Acnes has been cultured from both the young control and more frequently in the older frozen shoulder group.It could be postulated from these results demonstrate a link between frozen shoulder and P.Acnes. However, a counter argument could be that it is inoculated into the shoulder from previous intervention such as an injection or arthroscopic procedure. Both the previous frozen shoulder group and control group have not had previous surgery (as an inclusion criteria), but may have had a GP or physiotherapist injection. This could be the source of inoculation.
If this is the case, it would be expected that patients undergoing revision surgery should have a much higher rate of culture for P.Acnes. Although P.Acnes has been grown in patients with a multitude of different shoulder pathology. No group has looked at the incidence in patients without any history of injection (as this would be extremely difficult to achieve due to the vast majority of patients undergoing at least one injection prior to operation). Also, no group has looked at the incidence of positive cultures in patients who have already had a shoulder operation. If the hypothesis of inoculation is correct, this group should have a 100% culture rate for P.Acnes.
REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
16/EM/0397
Date of REC Opinion
27 Sep 2016
REC opinion
Further Information Favourable Opinion