Modifiable risk factors for culture positivity after primary Latarjet procedure. Should we change any practice?

Background

The prevalence of positive cultures in primarily operated shoulders represents a growing concern. Previous studies have documented high rates of culture positivity in primary prosthetic shoulder surgery, yet the Latarjet procedure has not been specifically explored in this context. The aim of this study was to identify the rate of culture positivity in patients treated with a primary Latarjet procedure and to identify risk factors for culture positivity.

Methods

This prospective, multicentric study conducted between September 2021 and October 2022 targeted patients undergoing primary open Latarjet procedures. Patients with a history of shoulder surgery were excluded. Six deep peroperative bacteriological samples were collected: 3 from soft tissues (capsulo-labral) and 3 from bony (glenoid) areas. The primary outcome was the rate of culture positivity. Secondary outcomes included the type of germs and the rate of complications. Risk factor analysis for positive cultures was undertaken using both univariate and multivariate analyses.

Results

This study encompassed 122 patients with a mean age of 26.63 ± 7.45. The rates of having at least 1, 2, and 3 cultures positive were 44.8%, 40.16%, and 34.43%, respectively. Predominantly, cultures yielded Cutibacterium acnes in 96.2% of cases. Multivariate analysis identified two main risk factors for culture positivity: preoperative shoulder CT arthrogram (CTA) use (odds ratio [OR] = 4.44, 95% confidence interval [CI] = 1.65-11.9, P = .003) for at least one positive culture. Alcoholic Betadine as skin preparation in a university hospital setting significantly increased the risk (OR = 16.1, 95% CI = 4.57-56.7, P < .001) for at least one positive culture. For at least 2 positive cultures, CTA (OR = 4.17, P = .005) and alcoholic Betadine in a university hospital setting (OR = 12.94, P < .001) remained significant risk factors. Similarly, for at least 3 positive cultures, CTA (OR = 3.88, P = .009) and alcoholic Betadine in a university hospital setting (OR = 8.85, P < .001) were the only significant risk factors. Elimination of preoperative CTA reduced the rate of positive cultures to 29.27%, 24.39%, and 19.51% for at least 1, 2, and 3 positive cultures. One patient who had positive culture experienced early sepsis caused by C acnes.

Conclusion

This study showed a high rate of positive cultures in Latarjet patients post surgeries. Analysis highlighted preoperative CTA use as a significant risk factor, increasing positive culture risk 4-fold.