2017 ISAKOS Biennial Congress ePoster #2107

 

The Effect of a Single-Application of 10% Benzoyl Peroxide Surgical Skin Preparation on the Incidence of Deep Colonization with P. Acnes in Shoulder Arthroscopy

Wesley M. Nottage, MD, Laguna Hills, CA UNITED STATES
Hailey H. Dizay, DO, Irvine, CA UNITED STATES
Diana J Lau, MD, Laguna Hills, CA UNITED STATES
Michael Chuang, MD, Laguna Hills, CA UNITED STATES
Vivian Mendoza, MD, Laguna Hills, CA UNITED STATES

The Sports Clinic, Laguna Hills, CA, UNITED STATES

FDA Status Cleared

Summary

Topical 10% Benzoyl Peroxide wash did not alter the rate of deep colonization wth P Acnes in Shoulder Arthroscopy

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Abstract

Background

Propionibacterium acnes (P. acnes) has been shown to be the primary causative pathogen in post-operative shoulder infections, from arthroplasty to arthroscopy. Current theory favors that the shoulder joint is inoculated with the bacteria during skin incision secondary to P. acnes colonization in the dermal layer of the skin. The purpose of our study was to investigate whether benzoyl peroxide is effective as a single application prior to intraoperative surgical skin preparation to decrease the skin colonization rate after the skin preparation, and decrease the intra-articular colonization rate of P. acnes in shoulder arthroscopy. Benzoyl peroxide has been reported by shoulder surgeons as part of their operative skin preparation, as well as having a known topical bactericidal effect when first applied.

Methods

Twenty one consecutive patients were indicated for shoulder arthroscopy. Cultures were taken in the operating room from the skin overlying the standard posterior, anterosuperior and anterolateral arthroscopy portal sites in 21 patients (16 male, 5 female). A benzoyl peroxide 10% wash was applied to the shoulder and left on for 1 minute. 10% solution was chosen for use since it would be used for only one minute, and present the highest concentration for its known bactericidal effect. This product was then removed with sterile saline and culture samples were recollected from the same portal sites prior to a standard surgical prep with chlorhexidine 4% scrub followed by a 2% chlorhexidine gluconate /70% isopropyl alcohol paint to the entire shoulder. Shoulder arthroscopy proceeded as indicated with final cultures from within the shoulder at the completed surgical site via a cannula.

Results

The pre-operative colonization rate of P. acnes on the skin surgical portal site was 80.9% (17 of 21 patients). The benzoyl peroxide wash eliminated P. acnes in 4 of 17 patients (23.5%), probably the topical bactericidal effect, but also produced positive cultures in 3 of 4 patients (75%) whose initial skin cultures were negative for the bacteria. There was overall no significant decrease in superficial P. acnes colonization rate at the skin following the 1 minute benzoyl peroxide surgical skin prep. The post-operative surgical site inoculation rate was similar to previous studies at 14.3% (3 of 21 patients), with 100% of deep cultures having a positive superficial skin culture for P. acnes. No patient demonstrated a skin reaction to the skin preparation technique.

Conclusions

Benzoyl peroxide 10% utilized as a single application surgical skin preparation for one minute was not effective at decreasing the colonization rates of cutaneous P. acnes prior to arthroscopic shoulder surgery, and did not decrease the incidence of deep colonization at the surgical site.