Randomized controlled trial of chlorhexidine wash versus benzoyl peroxide soap for home surgical preparation: neither is effective in removing Cutibacterium from the skin of shoulder arthroplasty patients
These authors point out that home chlorhexidine washes prior to shoulder surgery are commonly used in an attempt to reduce the skin bacterial load. However, recent studies have suggested that this agent is relatively ineffective against Cutibacterium acne.
Benzoyl peroxide (BPO) soap is a treatment for acne, but evidence regarding its effectiveness as prophylaxis in shoulder surgery is lacking.
The objective of their study was to compare the effectiveness of home chlorhexidine washes with benzoyl peroxide soap in patients undergoing shoulder arthroplasty surgery in reducing Cutibacterium levels on the skin surface and in the dermis.
50 male patients planning to undergo shoulder arthroplasty were consented to be randomized into treatment with 4% chlorhexidine solution (CHG) or 10% benzoyl peroxide soap (BPO) used to wash the operative shoulder the night prior and morning of surgery.
Skin swabs prior to incision and swabs of the dermis incised after standard skin preparation and preoperative IV antibiotics were obtained, and the bacterial load was reported in a semiquantitative manner as the Specimen Cutibacterium Value (SpCuV).
Skin surface swabs were positive in 100% of patients using CHG and 100% of patients using BPO soap.
The Cutibacterium load (SpCuV) on the skin surface was similar between the two groups (CHG 1.6 ± 1.1 vs. BPO 1.5 ± 1.4, p = 0.681).
The percentages of dermal cultures that were positive were not significantly different between the two groups (CHG 61% vs BPO 46%, p = 0.369).
The Cutibacterium load (SpCuV) on the incised dermal edge was similar between the two groups (CHG 0.8 ± 1.0 vs. BPO 0.8 ± 1.4, p = 0.991).
The authors concluded that neither BPO soap nor chlorhexidine washes prior to shoulder surgery were effective in eliminating Cutibacterium from the skin surface or the incised dermal edge.
Comment: It is of great concern that neither preoperative wash coupled with standard skin preparation and IV antibiotics were effective in eliminating Cutibacterium - the most common organism to cause periprosthetic infections of the shoulder - from the incised dermis. This suggest that many arthroplasty incisions are contaminated by this organism and that this contamination may be best managed by such means as Betadine irrigation and topical in-wound antibiotics.
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