Conclusion There are many risk factors associated with developing an infection after elective shoulder surgery .
The findings of this systematic review are clinical ly relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden .
Purpose Infection is a concern after all orthopedic procedures , including shoulder surgery .
This systematic review of literature aim ed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery .
Frequent isolation of Propionibacterium acnes from the shoulder dermis despite skin preparation and prophylactic antibiotics.
BACKGROUND In vitro , Propionibacterium acnes ( P acnes ) is highly susceptible to commonly used antibiotics and antiseptics , yet in vivo , it still causes postsurgical infections of the shoulder . We hypothesized that the local environment within the pilosebaceous gl and s protects P acnes and that incision of the skin transects these gl and s , exposing viable P acnes to the wound . METHODS Fifty consecutive patients undergoing open shoulder surgery were prospect ively studied .  Prophylactic antibiotics were administered to all patients . Microbiologic swabs of the skin surface were taken before and after skin preparation with 70 % alcoholic chlorhexidine . The skin was incised , and a further swab and dermal biopsy specimen were taken . RESULTS P acnes was cultured in 21 of 50 prepreparation skin surface swabs ( 42 % ) , 7 of 50 postpreparation skin surface swabs ( 14 % ) , 26 of 50 dermal swabs ( 52 % ) , and 20 of 50 dermal biopsy specimens ( 40 % ) . There was a significantly higher incidence of P acnes growth from the skin surface ( P = .009 ) and dermis ( P = .01 ) of patients aged ≤50 years old and in the dermal biopsy specimens of patients undergoing revision surgery ( P = .01 ) and a trend toward increased incidence of P acnes in men .  P acnes growth from a prepreparation skin surface swab had a sensitivity of 69 % , specificity of 88 % , positive predictive value of 86 % , and negative predictive value of 72 % at predicting subsequent P acnes growth from the dermal swab or biopsy specimen . CONCLUSIONS Viable P acnes persists within the skin dermis , despite st and ard antimicrobial pre caution s. These findings suggest that incising the skin is likely to lead to deep seeding of the surgical wound , which has implication s for the pathogenesis and prevention of postsurgical shoulder infections
Conclusion There are many risk factors associated with developing an infection after elective shoulder surgery .
The findings of this systematic review are clinical ly relevant as it has been shown that infection after shoulder surgery results in poor patient-reported outcomes and pose a significant financial burden .
Purpose Infection is a concern after all orthopedic procedures , including shoulder surgery .
This systematic review of literature aim ed to determine risk factors for infection as well as the availability and effectiveness of measures utilized to prevent infection after elective shoulder surgery .