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Does application of hydrogen peroxide to the dermis reduce incidence of Cutibacterium acnes during shoulder
Gagan Grewal1, Teja Polisetty2, Andrew Boltuch1
1Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
Introduction:
Prosthetic joint infections (PJIs) following shoulder arthroplasty are a major source of morbidity and are most commonly caused by Cutibacterium acnes, a bacteria found concentrated in the dermis. Skin preparation using hydrogen peroxide has been shown to reduce positive cultures; however, direct application to the dermis has not been investigated. The purpose of this study is to determine whether the application of hydrogen peroxide to the dermis affects the incidence of positive C acnes cultures.
Methods:
A prospective, randomized controlled trial of patients undergoing primary shoulder arthroplasty by a single fellowship-trained surgeon was performed between February and November 2020. Enrolled 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. Laboratory personnel and patients were blinded to randomization, and all cultures were held for 14 days. Culture positivity rate along with culture site, day of culture positivity, and bacterial abundance of positive cultures were analyzed. Stratified analysis by gender and age of ≤69 years was also performed.
Results:
Sixty patients undergoing primary arthroplasty were randomized. The group receiving hydrogen peroxide (n =30) and the control group (n = 30) were similar in age (71.1 ± 7.1 vs. 73.4 ± 9.8; P = .30), body mass index (29.4 ± 5.7 vs. 28.5 ± 6.0; P = .57), gender (P = .64), hand dominance (P = .65), and surgery type (P = .90). The overall rate of at least 1 positive culture was 18%. All positive cultures were C acnes. The positive culture rate in the hydrogen peroxide (20%) and control group were similar (16%; P > .99). There were no positive glenohumeral joint cultures and no wound complications. There was no significance difference in the culture site, day of culture positivity, and bacterial abundance. Stratification analysis by gender and age also demonstrated similar rates of C acnes between study groups.
Conclusion:
Standard skin preparation and antibiotic prophylaxis results in an overall low rate of skin and dermis culture positivity. The use of hydrogen peroxide after initial incision did not significantly alter the rate of positive C acnes cultures during shoulder arthroplasty and did not increase wound complications.
Insights
Adding hydrogen peroxide to the dermis during shoulder arthroplasty did not reduce Cutibacterium acnes cultures. This study found no significant difference in positive cultures or wound complications when using hydrogen peroxide for prosthetic joint infection prevention.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Microbiology
Background:
- Prosthetic joint infections (PJIs) following shoulder arthroplasty are a significant cause of morbidity.
- Cutibacterium acnes is the most common pathogen in PJIs and resides in the dermis.
- Standard skin preparation may not fully eliminate C. acnes from the dermis.
Purpose of the Study:
- To investigate the efficacy of intraoperative dermal hydrogen peroxide application in reducing C. acnes.
- To determine if hydrogen peroxide impacts positive culture rates in shoulder arthroplasty.
Main Methods:
- Prospective randomized controlled trial involving 60 patients undergoing primary shoulder arthroplasty.
- Patients received standard care or standard care plus dermal hydrogen peroxide post-incision.
- Dermal and joint cultures were analyzed for C. acnes, with blinding of personnel and patients.
Main Results:
- No significant difference in the overall positive culture rate (18%) between the hydrogen peroxide group (20%) and the control group (16%).
- All positive cultures identified were C. acnes; no joint cultures were positive.
- No increase in wound complications was observed with hydrogen peroxide use.
Conclusions:
- Intraoperative dermal application of hydrogen peroxide did not significantly reduce C. acnes positive cultures in shoulder arthroplasty.
- Standard skin preparation and antibiotic prophylaxis appear effective in maintaining low culture positivity rates.
- Hydrogen peroxide did not increase the risk of complications in this study cohort.
