For Cutibacterium Acnes (C. Acnes) elimination, preoperative skin preparations for total shoulder arthroplasty (TSA) are not standardized. The bacterial burden of C. Acnes’s demonstration on the skin can reduce by topical Benzoyl Peroxide (BPO) and Benzyl Peroxide with Clindamycin (BPO/C). The study aimed to see if using these topical antimicrobials before surgery reduced C. Acnes superficial colonization and deep tissue inoculation in total shoulder arthroplasty patients. About 101 patients with primary TSA were randomized to receive topical Phisohex (Hexachlorophene: 1 % triclosan, sodium benzoate 5mg/mL benzyl alcohol 5mg/mL) (35), 5% Benzoyl Peroxide (33), or 5% Benzyl Peroxide with 1% Clindamycin in a prospective, single-blinded randomized control trial (33). Skin swabs were taken before topical application, after topical treatment before the operation, and three times during surgery. The dermis was cultured after incision, joint capsule entry, and wound closure. Positive cultures and successful decolonization were the primary outcomes.

All three topical medications were successful in reducing C. Acnes rates. Phisohex, BPO, and BPO/C reduced skin colonization by 50%, 73.7%, and 81.5%, respectively. Topical formulations of BPO/C were more effective than Phisohex. During the preoperative and intraoperative swab periods, the findings of BPO by researchers were to reduce the rate of C. Acnes (p=0.003). Deep tissue injection is almost always the outcome of failing to eradicate C. Acnes using topical treatments. Compared to skin cultures taken before surgery, there was a 33% rise in C. Acnes contamination on the skin after closure (22%). In patients having total shoulder arthroplasty, topical use of Benzoyl Peroxide and Benzoyl Peroxide with Clindamycin is more effective than Phisohex in minimizing colonization and contamination of the surgical field with C. Acnes.

 

Reference:www.jshoulderelbow.org/article/S1058-2746(22)00229-4/fulltext