Thursday, June 11, 2015

Shoulder surgery, can benzoyl peroxide reduce Propionibacterium levels on the skin?

Efficacy of topical benzoyl peroxide on the reduction ofPropionibacterium acnes during shoulder surgery

The authors treated 50 patients undergoing first-time arthroscopic shoulder surgery with topical 5% benzyol peroxide cream 48 hours before surgery.  The treatment was started 2 mornings before surgery and BPO was applied by the patient to the shoulder and armpit areas twice a day. After skin preparation, 13 samples per subject were obtained and cultured for 14 days.

The skin was positive at the initiation of surgery in 6% of cases. Tissue samples were positive in 6%. The skin was positive in 10% at the end of surgery. None of these rates of positive culture were different from the 4% rate observed with a control swab.

Our graph of their results is shown below, showing percent of positive cultures for different specimen sources. Of note is the fact that the preoperative skin cultures were obtained after IV cephalosporin (or clindamyin) but before the skin prep. Other cultures were taken of the BPO treated operative side after skin prep with Chloroprep, but there was no control from non BPO sites prepped with Chloroprep.

Comment: The rate of positive skin swab cultures for Propionibacterium was lower for skin treated with benzoyl peroxide than for untreated skin on the contralateral side. 

It is of interest to note that 4% of the cultures of swabs exposed to air were positive. If this is to be attributed to contamination, it would be of interest to know if these swabs cultured positive for organisms other than Propionibacterium.

It would also be of interest to know if patients had any adverse reactions to the BPO, such as skin rash, that might present problems in using this agent on skin to be incised. 

This work is important in that it does demonstrate the effectiveness of a non-antibiotic agent in reducing the rate of positive skin cultures for Propi.

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