Acne cream reduces the deep Cutibacterium acnes tissue load before elective open shoulder surgery: a randomized controlled pilot trial

Unterfrauner, Ines; Wieser, Karl; Catanzaro, Sabrina; Uçkay, İlker; Bouaicha, Samy

doi:10.1016/j.jse.2022.01.115

Cited by 10 publications

(6 citation statements)

References 51 publications

(58 reference statements)

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“…There were five level I studies (26,27,33,35,37) and five level II studies (25,28,32,34,36). A total of 9 studies were from the same journal.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Previous studies on the inclusion of BPO were limited, and the evidence level was low, which lacked convincing evidence (23, 24). As several new studies (25)(26)(27)(28) have been published, an updated systematic review and meta-analysis should be conducted. This study aimed to assess the safety and efficiency of BPO application in the shoulder to decrease C. acnes.…”

Section: Introductionmentioning

confidence: 99%

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The safety and efficiency of benzoyl peroxide for reducing Cutibacterium acnes in the shoulder: An updated systematic review and meta-analysis

Fan

Ma²,

Liu³

et al. 2023

Front. Surg.

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BackgroundCutibacterium acnes (C. acnes), a common pathogen, contributes significantly to infections in shoulder surgery. Prevention of shoulder infection is crucial to improve postoperative functional recovery and reduce costs. This study aimed to perform a systematic review and meta-analysis to assess the safety and efficacy of 5% benzoyl peroxide (BPO) application in the shoulder to decrease C. acnes.MethodsThree electronic databases were searched as follows: PubMed, Embase, and the Cochrane Library databases. Data extraction for this study was performed by two independent reviewers, and only level I and level II studies were included. The outcome data sources of individual studies were pooled. The fixed-effect model was used to determine the meta-analysis.ResultsThere were five level I studies and five level II studies. The results showed that the 5% BPO group had a lower risk of C. acnes positivity [OR, 0.21 (0.15, 0.30), I2 = 24, p < 0.00001]. The pooled analysis results showed that there was no significant difference in the ability of 5% BPO and 5% BPO + clindamycin to reduce C. acnes. However, the lower rate of adverse events was significantly in favour of the non-BPO group compared with the 5% BPO group.ConclusionBPO can decrease C. acnes in the shoulder to prevent infection. However, the combination of BPO and clindamycin does not enhance this effect further.Level of evidenceII, Systematic review and meta-analysis.

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“…There were five level I studies (26,27,33,35,37) and five level II studies (25,28,32,34,36). A total of 9 studies were from the same journal.…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The safety and efficiency of benzoyl peroxide for reducing Cutibacterium acnes in the shoulder: An updated systematic review and meta-analysis

Fan

Ma²,

Liu³

et al. 2023

Front. Surg.

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“…MN application may make the bacterial cell membrane more permeable to BPO producing a synergistic effect. Unterfrauner et al 27 showed that daily application of commercial acne cream (5% BPO and 2% MN) for 7 days preoperatively reduced the number of intraoperative positive cultures (8 of 18 vs. 16 of 19; p = 0.01). When compared with 5% BPO alone 31,32 , the number of patients with detectable C. acnes on the skin surface was lower in this study using 5% BPO with 2% MN (58%-65% vs. 44%) 27 .…”

Section: Prehospitalization Preoperative Skin Regimensmentioning

confidence: 99%

“…Benzoyl peroxide (BPO) is an antibacterial agent that has bactericidal effects through the release of reactive oxygen species 27 . BPO is lipophilic, allowing penetration into the pilosebaceous glands 28 .…”

Section: Prehospitalization Preoperative Skin Regimensmentioning

confidence: 99%

Techniques for Decreasing Bacterial Load for Open Shoulder Surgery

et al. 2022

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Benzoyl peroxide (BPO) 5% has been shown to reduce Cutibacterium acnes load on the skin. BPO 5% with miconazole nitrate (MN) 2% may be beneficial, whereas BPO 5% with clindamycin cream 1% to 1.2% does not seem to have additive effects when compared with BPO 5% alone. Chlorhexidine gluconate solutions reduce the total bacterial load on the skin, but do not seem to have a significant effect on C. acnes.» ChloraPrep seems to be the best surgical skin preparation to decrease overall positive skin cultures. Preincisional hydrogen peroxide 3% application has been shown to be a cost-effective practice to inhibit growth of C. acnes. Vancomycin powder before deltopectoral interval closure has antimicrobial effects against C. acnes and is a cost-effective practice. Finally, Bactisure surgical lavage is protective against the formation of biofilms.» IV cefazolin has been shown to be more effective for shoulder arthroplasty infection prophylaxis than antibiotic alternatives such as vancomycin. Thus, patients with a questionable history of penicillin allergy should undergo additional testing.

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“…The distribution of octenisan® wash lotion and octenisan® nasal gel in the form of a set (octenisan® set) facilitates the application and the compliance efforts for our study. Academically, we will gain more insight in the performance of the decolonization for a patient population at high risk of infectious complications (SSIs and wound problems), for whom every preventive effort is of utmost importance [1,[17][18][19][20][21][22].…”

Section: Introduction Background and Rationalementioning

confidence: 99%

General Skin and Nasal Decolonization with octenisan® Set before and after Elective Orthopedic Surgery in Selected Patients at Elevated Risk for Revision Surgery and Surgical Site Infections - A Single-Center, Unblinded, Superiority, Randomized-Controlled Trial (BALGDEC Trial)

Unterfrauner

Bragatto-Hess

Studhalter

et al. 2023

Preprint

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Background The preoperative body surface and nasal decolonization may reduce the risk of surgical site infections (SSI), but yields conflicting results in the current orthopedic literature. Methods We perform a single-center, randomized-controlled, superiority trial in favor of the preoperative decolonization using a commercial product (octenidin® set). We will randomize a total number of 1,000 adult elective orthopedic patients with a high risk for SSI and/or wound complications (age ≥ 80 years, chronic immune-suppression, American Society of Anesthesiologists’-Score 3–4 points) between a decolonization (octenisan® wash lotion 1 x per day and octenisan® md nasal gel 2–3 x per day; during five days) and no decolonization. Decolonized patients will additionally fill a questionnaire regarding the practical difficulties, the completeness, and the adverse events of decolonization. The primary outcomes are SSI and revision surgeries for postoperative wound problems until six weeks postoperatively (or 1 year for surgeries with implants or bone). Secondary outcomes are unplanned revision surgeries for non-infectious problems and all adverse events. With 95% event-free surgeries in the decolonization arm versus 90% in the control arm, we formally need 2 x 474 elective orthopedic surgeries included during two years. Discussion In selected adult orthopedic patients with a high risk for SSI, the presurgical decolonization may reduce postoperative wound problems, including SSI. Trial registration ClinicalTrial.gov NCT05647252. Registered on 9 December 2022. Protocol version 2 (5 December 2022)

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Acne cream reduces the deep Cutibacterium acnes tissue load before elective open shoulder surgery: a randomized controlled pilot trial

Cited by 10 publications

References 51 publications

The safety and efficiency of benzoyl peroxide for reducing Cutibacterium acnes in the shoulder: An updated systematic review and meta-analysis

The safety and efficiency of benzoyl peroxide for reducing Cutibacterium acnes in the shoulder: An updated systematic review and meta-analysis

Techniques for Decreasing Bacterial Load for Open Shoulder Surgery

General Skin and Nasal Decolonization with octenisan® Set before and after Elective Orthopedic Surgery in Selected Patients at Elevated Risk for Revision Surgery and Surgical Site Infections - A Single-Center, Unblinded, Superiority, Randomized-Controlled Trial (BALGDEC Trial)

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