Related Experiment Video
Updated: Aug 22, 2026
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Preoperative benzoyl peroxide 5% reduces early Cutibacterium acnes-related postoperative spinal implant infections: a
Giacomo Franceschi1,2, Mattia Marchi3, Eugenio Dema4
1Department of Infectious Diseases, Policlinico di Modena, Modena, Italy.
Aims:
Postoperative spinal implant infections (PSIIs) are serious complications in spinal deformity surgery, with Cutibacterium acnes representing a frequent pathogen. This study aimed to evaluate whether adding of preoperative topical benzoyl peroxide (BPO) 5% to standard antibiotic prophylaxis could reduce early C. acnes-related and overall PSIIs.
Methods:
A retrospective quasi-experimental study was performed at a tertiary spinal surgery center, including two sequential 12-month cohorts of patients undergoing corrective spinal surgery. The control group received standard intravenous antibiotic prophylaxis, while the intervention group received additional topical BPO 5% applied twice daily for three days before surgery. The primary outcome was the incidence of early C. acnes PSIIs within 90 days; the secondary outcome was the incidence of overall early PSIIs.
Results:
A total of 160 patients were analyzed (80 per group). Baseline demographic and surgical characteristics were comparable. Early PSIIs occurred in 12 patients (7.5% overall). The incidence was significantly lower in the BPO group compared with the standard care group (2.5% vs. 12.5%, p = 0.036). C. acnes-related PSIIs occurred in one patient (1.3%) in the BPO group and six patients (7.5%) in the control group, representing a numerical reduction that did not reach statistical significance (HR:0.182[95%CI:0.022;1.52]). Cox regression showed lower hazard of overall infection in the BPO group compared with the SoC group (HR:0.21[95%CI:0.046;0.960]), although based on a small number of infections.
Conclusion:
Preoperative application of BPO 5%, in combination with standard antibiotic prophylaxis, was associated with a significant reduction in overall early PSIIs and with a clinically meaningful but statistically non-significant reduction in C. acnes-related PSIIs. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies. This simple, low-cost, and readily implementable adjunct may represent an effective addition to infection-prevention strategies in spinal surgery.
Insights
Adding topical benzoyl peroxide (BPO) 5% before spinal surgery significantly reduced overall postoperative spinal implant infections (PSIIs). While Cutibacterium acnes infections saw a numerical decrease, further research is needed to confirm this effect.
Area of Science:
- Spinal Surgery
- Infectious Disease Prevention
- Dermatology
Background:
- Postoperative spinal implant infections (PSIIs) are a significant concern in spinal deformity surgery.
- Cutibacterium acnes is a common pathogen contributing to PSIIs.
- Standard antibiotic prophylaxis may not fully prevent these infections.
Purpose of the Study:
- To investigate the efficacy of preoperative topical benzoyl peroxide (BPO) 5% in reducing early PSIIs.
- To assess the impact of BPO on both overall PSIIs and Cutibacterium acnes-related infections.
Main Methods:
- A retrospective quasi-experimental study involving 160 patients undergoing corrective spinal surgery.
- Two groups were compared: standard antibiotic prophylaxis versus standard prophylaxis plus topical BPO 5% applied preoperatively.
- Primary outcome: incidence of early C. acnes PSIIs; Secondary outcome: incidence of overall early PSIIs.
Main Results:
- The BPO group showed a significantly lower incidence of overall early PSIIs (2.5%) compared to the control group (12.5%, p=0.036).
- A numerical reduction in C. acnes-related PSIIs was observed in the BPO group (1.3%) versus the control group (7.5%), but this did not reach statistical significance.
- Cox regression indicated a lower hazard of overall infection in the BPO group (HR:0.21).
Conclusions:
- Preoperative topical BPO 5% combined with standard antibiotic prophylaxis significantly reduced overall early PSIIs.
- The reduction in C. acnes-related PSIIs was clinically meaningful but not statistically significant, suggesting a need for larger studies.
- Topical BPO presents a simple, low-cost adjunct for enhancing infection prevention in spinal surgery.
