These authors conducted a prospective, randomized control trial of patients undergoing primary shoulder arthroplasty in which patients were randomized to either receive standard skin preparation and antibiotic prophylaxis with or without an additional application of hydrogen peroxide to the dermis following incision. Culture samples were taken from the skin, dermis, glenohumeral joint and air.
The overal rate of at least one positive culture was 18%. 10% of patients were found to have 2 positive cultures All positive cultures were Cutibacterium. The positive culture rate in the hydrogen peroxide (20%) and control group (16%) were similar.
There were no positive cultures from the glenohumeral joint or air samples. One patient had an isolated positive skin culture (hydrogen peroxide group). Four patients had isolated positive dermis cultures (2 hydrogen peroxide group; 2 control). The remaining 6 patients had positive cultures in both the skin and dermis (3 hydrogen peroxide group; 3 control).
Subgroup analysis by gender and age demonstrated the male ≤69 years subgroup had a higher incidence (44%; 7/16) of positive cultures than older males (23%; 3/13) and older females (4.4%; 1/23). There were no positive cultures in the female ≤69 years subgroup.
Patients with positive cultures were significantly younger in age (67.5 ± 8.4 vs 73.3 ± 8.3; and had a higher percent of males (91% vs 39%; than patients with negative cultures.
Comment: This article again confirms the increased prevalence of Cutibacterium in the skin of young male patients having shoulder arthroplasty and that prophylactic measure are not successful in eliminating these bacteria.
