These authors evaluated the prevalence of Cutibacterium acnes in 48 patients having shoulder arthroscopy. After hair removal with a medical clipper and routine antibiotic prophylaxis, swabs were taken from shoulder skin in the anterior, medial, posterior, and axillary regions before and after skin preparation with an alcohol-based skin disinfectant and at the conclusion of surgery.
64.6% of patients had at least 1 skin positive culture for C acnes. The C acnes prevalence was significantly higher in male patients (48.3%) than female patients (20.1%, P < .001).
They found that the rate of C acnes positive skin cultures increased from 27.6% before skin preparation to 31.3% after skin preparation to 44.3% at the end of the case. Among the four skin areas, the axilla was least likely to be culture positive.
They concluded that skin contamination with C acnes around the shoulder increased significantly from before and after skin preparation to the conclusion of surgery in patients undergoing shoulder arthroscopy despite perioperative preventive measures. They suggest that instrumentation through the arthroscopic portals may have brought Cutibaterium from the pilosebaceous units of the dermis to the skin surface, resulting in an increase in the percentage of cultures that were positive at the end of the case.
Comment: This study points out again that routine prophylactic measures do not eliminate Cutibacterium from the skin. There have been reports of Cutibacterium contamination of arthroscopic cuff repairs (see this link and this link). The causative role of Cutibacterium in failed arthroscopic surgery remains to be defined.
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