Tuesday, November 6, 2018

Benzoyl peroxide is effective in reducing Propionibacterium on the skin of patients having shoulder surgery

Benzoyl peroxide effectively decreases preoperative Cutibacterium acnes shoulder burden: a prospective randomized controlled trial

Benzoyl peroxide (BPO) solutions effectively reduce Cutibacterium acnes (formerly Propionibacterium acnes) on the face, neck, and back in nonoperative settings. These authors compared preoperative application of BPO vs. chlorhexidine gluconate (CHG) in decreasing shoulder C acnes skin burden in surgical patients.

Eighty patients undergoing shoulder surgery were prospectively enrolled in a randomized double blind trial from August 2015 to April 2017. Participants were randomized to 5% BPO or 4% CHG for 3 consecutive days. Washes with either BPO or CHG were carried out  3 times before shoulder surgery

The nonoperative shoulder had no intervention and served as the negative control. Skin cultures of both shoulders were obtained via a detergent scrub technique the day of surgery at anterior, lateral, and posterior sites and the axilla.

Fewer positive cultures were obtained from the BPO-treated side compared with the contralateral side (P = .0003), and no change was shown for the CHG group (P = .80). Shoulders treated with BPO showed a statistically significant reduction in C acnes counts compared with CHG at anterior (P = .03) and posterior (P = .005) portal sites. No significant difference was found at the axilla (P = .99) or lateral portal site (P = .08). No postoperative infections or wound complications occurred in either group.

These authors concluded that BPO is more effective than CHG at reducing C acnes on the shoulder. Decreasing the skin burden of C acnes may reduce intraoperative wound contamination and postoperative infection. They suggest that BPO should be considered as an adjunctive preoperative skin preparation considering its potential benefit, low risk, and low cost.

Comment: BPO has been a well accepted approach for treating acne for many years. It apparently can penetrate down to the level of the dermal sebaceous glands which are thought to contain cute bacterium, especially in young males. Its bactericidal effect on C acnes is thought to be through a free radical mechanism that avoids the issue of antibiotic resistance.

BPO is inexpensive (about $10 per patient).

Contact dermatitis related to BPO use has been reported in 2.5% of patients.

5% BPO solutions appear to avoid negative adverse effects such as irritation and clothing bleaching, which have been observed with higher concentrations.

BPO has not been shown to adversely affect wound healing.

So, in conclusion, BPO appears to hold promise for reducing cutibacterium (propionibacterium) loads in shoulder surgery.

We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art"  regarding this radically conservative approach to shoulder arthritis at this link and this link

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