Topical Benzoyl Peroxide Reduces Risk of Infection During Shoulder Surgery
GREENWICH, Conn -- June 30, 2015 -- A study published in the Journal of Shoulder and Elbow Surgery showed that topical benzoyl peroxide (BPO), with chlorhexidine skin preparation, reduces the number of positive Propionibacterium acnes cultured during shoulder surgery.
P acnes infection is a significant problem after shoulder surgery. Residual P acnes is found on the skin up to 29% of the time immediately after surgical skin preparation and in 70% of dermal biopsy specimens. These residual bacteria may be a source for infection. Identifying more ideal skin preparation may help reduce the risk of infection.
For the study, 50 patients undergoing first-time shoulder surgery were treated with topical 5% BPO cream 48 hours before surgery. After skin preparation, 13 samples per subject were obtained. These cultures were held for 14 days and 650 culture specimens were obtained.
The skin was positive at the initiation of surgery in 6% of the cases and tissue samples were positive in 6%. The skin was positive in 10% at the end of surgery. None of these rates of positive culture were different from the 4% rate observed with a control swab.
Application of BPO is an effective way to reduce P acnes on skin at the beginning and, importantly, at the end of a surgical procedure, the authors said. This may result in a lower risk for postoperative infection.
“The setbacks and costs associated with infection after shoulder surgery are significant,” said senior author Paul M. Sethi, MD, Orthopedic Surgery Yale University School of Medicine, New Haven, Connecticut. “Our first study identified the patients' skin as the source of bacteria that may cause infection and highlighted the limitations of current skin surgical preparation. Our team used established dermatologic principles to improve the way we clean the skin. Dermatologists have used BPO to treat P acnes on our face for 50 years. We chose to study this same medicine on the shoulder and the findings are very exciting. Data demonstrates that we can significantly reduce potentially dangerous bacteria after skin treatment with BPO. By reducing these bacteria, we hope to reduce the risk for shoulder infection following surgery.”