Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA.
J Shoulder Elbow Surg. 2011 Sep;20(6):928-33. doi: 10.1016/j.jse.2011.02.018. Epub 2011 May 25.
Deep infection after shoulder surgery is a rare but devastating problem. This study tested the hypothesis that the home application of a 2% chlorhexidine gluconate cloth before shoulder surgery would be more efficacious than a standard shower of soap and water at decreasing the preoperative cutaneous levels of pathogenic bacteria on the shoulder.
This randomized, prospective study evaluated 100 consecutive patients undergoing shoulder surgery. Patients were randomly assigned to use 2% chlorhexidine gluconate-impregnated cloths (treatment group) or to shower with soap and water before surgery (control group). Cutaneous cultures were taken from the patients'shoulders in the preoperative holding area. Patients were monitored for 2 months postoperatively for clinical signs of infection.
In the treatment group vs the control group, the overall positive culture rate was 66% vs 94% (P = .0008), and the positive culture rate for coagulase-negative Staphylococcus was 30% vs 70% (P = .0001). The positive culture rate for Propionibacterium acnes was 46% in the treatment group vs 58% in the control group (P = .32). No infections occurred in any patients at a minimum of 2-months after surgery.
The use of the 2% chlorhexidine cloth was effective at decreasing overall bacterial culture rates before shoulder surgery and was particularly effective at decreasing the quantity of coagulase-negative Staphylococcus, a known causative agent of postoperative shoulder infections.
Use of chlorhexidine impregnated cloths prior to shoulder surgery may be a useful adjunct to presently used infection prevention strategies.
肩部手术后深部感染是一种罕见但破坏性很大的问题。本研究检验了以下假设，即在肩部手术前使用 2%葡萄糖酸氯己定布进行家庭应用会比使用肥皂和水进行标准淋浴更有效地降低术前肩部皮肤的致病性细菌水平。
这是一项随机、前瞻性研究，评估了 100 例连续接受肩部手术的患者。患者被随机分配使用 2%葡萄糖酸氯己定浸渍布（治疗组）或在手术前用肥皂和水淋浴（对照组）。在术前等候区从患者的肩部采集皮肤培养物。术后 2 个月监测患者是否有感染的临床迹象。
在治疗组与对照组中，总体阳性培养率分别为 66%和 94%（P<.0008），凝固酶阴性葡萄球菌的阳性培养率分别为 30%和 70%（P<.0001）。治疗组中痤疮丙酸杆菌的阳性培养率为 46%，对照组为 58%（P =.32）。术后至少 2 个月，没有任何患者发生感染。
在肩部手术前使用 2%葡萄糖酸氯己定布可有效降低整体细菌培养率，特别是降低凝固酶阴性葡萄球菌的数量，凝固酶阴性葡萄球菌是术后肩部感染的已知病原体。
在肩部手术前使用氯己定浸渍布可能是目前使用的感染预防策略的有用辅助手段。
