Benzoyl peroxide and clindamycin topical skin preparation decreases Propionibacterium acnes colonization in shoulder
Hailey H Dizay1, Diana G Lau1, Wesley M Nottage1
1The Sports Clinic Orthopaedic Medical Associates, Laguna Hills, CA, USA.
Background:
Propionibacterium acnes is a gram-positive anaerobe that can lead to devastating postoperative shoulder infections. The objective of this study was to investigate whether a benzoyl peroxide and clindamycin preoperative skin preparation reduces the incidence of P. acnes colonization during shoulder arthroscopy.
Methods:
Sixty-five shoulder arthroscopy patients were prospectively enrolled. A skin culture specimen was taken at the preoperative visit from standard arthroscopic portal sites. Topical benzoyl peroxide 5% and clindamycin 1.2% (BPO/C) gel was applied to the shoulder every night before surgery. Skin culture was repeated in the operating room before preparation with chlorhexidine gluconate. Shoulder arthroscopy proceeded, with final culture specimens obtained from within the shoulder.
Results:
P. acnes skin colonization remained similar to prior studies at 47.7% (31 of 65 patients.) With >1 application, BPO/C was 78.9% (15 of 19 patients) effective in eliminating P. acnes superficial colonization. With 1 application, it was 66.7% (8 of 12 patients) effective in eliminating superficial colonization. Deep colonization was reduced to 3.1% (2 of 65 patients) compared with previous studies of 15% to 20% (P = .006). BPO/C was 100% effective at decreasing deep colonization with >1 application.
Conclusions:
P. acnes skin colonization is high at arthroscopic shoulder portals, especially in men. Despite standard skin preparation and prophylactic antibiotics, the rate of joint inoculation is much higher than the rate of infection reported in the literature. BPO/C effectively reduces P. acnes colonization in shoulder arthroscopy. It should be considered for use before shoulder procedures with a time-related trend of >1 application.
Insights
Preoperative skin preparation with benzoyl peroxide and clindamycin gel significantly reduced deep Propionibacterium acnes colonization in shoulder arthroscopy patients. This treatment is effective in preventing P. acnes contamination during shoulder surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Dermatology
Background:
- Propionibacterium acnes (P. acnes) is a common cause of severe postoperative shoulder infections.
- High rates of P. acnes colonization exist at arthroscopic shoulder portals, particularly in men.
- Standard preoperative skin preparation and antibiotics may not fully prevent joint inoculation.
Purpose of the Study:
- To evaluate the efficacy of a benzoyl peroxide and clindamycin (BPO/C) preoperative skin preparation in reducing P. acnes colonization during shoulder arthroscopy.
Main Methods:
- Sixty-five patients undergoing shoulder arthroscopy were prospectively enrolled.
- Skin cultures were obtained preoperatively and intraoperatively.
- Patients applied topical BPO/C gel nightly before surgery.
Main Results:
- Superficial P. acnes colonization was reduced by BPO/C, with higher efficacy (>1 application) at 78.9%.
- Deep P. acnes colonization was significantly reduced to 3.1% (P=.006) compared to historical rates of 15-20%.
- Multiple applications of BPO/C achieved 100% effectiveness in decreasing deep colonization.
Conclusions:
- P. acnes colonization at shoulder arthroscopy portals is prevalent.
- BPO/C effectively reduces P. acnes colonization, especially deep colonization, in shoulder arthroscopy.
- Consider BPO/C for preoperative skin preparation in shoulder procedures, particularly with multiple applications.
