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Preoperative topical 5% benzoyl peroxide reduces intraoperative deep cutibacterium acnes contamination in shoulder
Xianzheng Jin1, Libei Fan1, Haifeng Zhou1
1Department of orthopedics, Zhe Jiang Jin Hua Guang Fu Tumor Hospital, Jinhua city, Zhejiang province, 321000, China.
Background:
Intraoperative deep contamination with Cutibacterium acnes (C. acnes) from hair follicles and sebaceous glands remains a microbiological risk in shoulder arthroscopy, and routine chlorhexidine-alcohol skin preparation has limited efficacy against this reservoir.
Objective:
To evaluate the association between preoperative topical 5% benzoyl peroxide use and intraoperative deep C. acnes contamination, and to explore skin colonization load.
Methods:
A retrospective cohort analysis was performed on patients undergoing shoulder arthroscopy. Deep specimens (synovial fluid, synovium, inner portal cannula wall) were obtained for anaerobic culture. The primary outcome was the patient-level deep contamination rate. Relative risks (RR), adjusted odds ratios (aOR), and incidence rate ratios (IRR) were estimated using multivariable logistic regression, Poisson regression, and non-parametric tests. Sensitivity analyses used a strict positivity definition.
Results:
The cohort included 162 patients (81 with BPO pretreatment, 81 with standard preparation alone). The BPO group had a lower deep contamination rate (16.05% vs. 34.57%; RR = 0.46, 95%CI 0.26-0.83, p = 0.007), with an adjusted aOR = 0.38 (95%CI 0.18-0.79). The number of positive deep specimens per patient was lower (IRR = 0.44, p = 0.004). Among positive cases, the time to culture positivity was delayed in the BPO group (p = 0.031). Preoperative skin colonization load was lower in the BPO group (p = 0.001). A higher skin score was independently associated with increased risk of deep contamination (aOR = 1.57 per 1-grade increase, 95%CI 1.19-2.07, p = 0.002). Sensitivity analyses showed consistent results. No significant between-group differences were found in short-term infection-related clinical events.
Conclusion:
In this retrospective analysis, preoperative topical 5% benzoyl peroxide was associated with a significant reduction in intraoperative deep C. acnes contamination and bacterial burden during shoulder arthroscopy, supporting the microbiological rationale for a source decolonization strategy.
Clinical Trial Registration:
Not applicable.
