Benzoyl Peroxide Wash Is Efficacious in Reducing Cutibacterium acnes Surgical Site Infections After Posterior Spine...

Cutibacterium acnes has been identified as a causative agent of spine surgical site infections (SSIs). Benzoyl peroxide (BPO) has long been used to treat acne vulgaris caused by C. acnes. In this study, we examined the efficacy of applying BPO to reduce SSIs after posterior spine surgeries.

Our institution implemented a new protocol in February 2024 to apply 5% BPO preoperatively to the surgical site for all patients undergoing posterior spine operations. These patients were compared with historical controls who underwent preoperative skin preparation with standard agents (eg, chlorhexidine gluconate). C. acnes SSI rates of BPO patients were compared with those of the historical control using the Fisher exact test.

From February 2024 to December 2024, 244 patients received preoperative 5% BPO. Our control group consisted of 924 patients from January 2022 to December 2024 who received standard skin preparation. BPO was well-tolerated, with no adverse events. None of the patients treated with 5% BPO had postoperative C. acnes SSIs, compared with 21 patients of the control group (P = .0122). The number needed to treat was 44 (95% CI 22.87-97.01), and the odds ratios was 0.0 (95% CI 0.0-0.61).

5% BPO gel is a safe, cost-effective, and efficacious prophylactic measure for the reduction of C. acnes SSIs in posterior spine procedures and should be considered if an institution is experiencing a meaningful number of infections attributed to C. acnes.