Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
J Shoulder Elbow Surg. 2019 Aug;28(8):1554-1561. doi: 10.1016/j.jse.2019.03.038. Epub 2019 Jun 20.
The purpose of this study was to determine whether preoperative skin preparation with hydrogen peroxide reduces intraoperative culture positivity for Cutibacterium acnes in shoulder arthroplasty.
This was a prospective, controlled, parallel/noncrossover, nonrandomized, single-blinded trial registered at clinicaltrials.gov. We included a consecutive series of patients scheduled to undergo primary anatomic or reverse total shoulder arthroplasty. The first group of patients underwent a standard skin preparation and the second group underwent the same preparation with the addition of hydrogen peroxide. We then took skin, dermis, glenohumeral joint, and air (negative control) aerobic and anaerobic culture swabs. We blinded the laboratory analyzing the samples. An a priori power analysis determined that 56 patients would be needed to see a 50% reduction in culture positivity rates. We also conducted a post hoc gender-stratified analysis.
Between January 2017 and October 2018, the authors performed 124 primary shoulder arthroplasties, of which we included 65 and collected samples on 61. There were no demographic differences. There were fewer patients within the peroxide group with triple-positive cultures (skin, dermis, and joint) (0% vs. 19%, P = .024) and positive cultures from the joint (10% vs. 35%, P = .031). In our subgroup analysis, these differences were only significant in males. The vast majority of positive cultures were with C. acnes.
Although larger, randomized studies are needed, adding hydrogen peroxide to the preoperative skin preparation may be a low-cost, low-risk method to reduce deep tissue contamination with C. acnes, particularly within males.
本研究旨在确定术前使用过氧化氢进行皮肤准备是否会降低肩关节炎置换术中痤疮丙酸杆菌的术中培养阳性率。
这是一项前瞻性、对照、平行/非交叉、非随机、单盲试验，在 clinicaltrials.gov 上注册。我们纳入了一系列计划接受原发性解剖或反向全肩关节置换术的连续患者。第一组患者接受标准皮肤准备，第二组患者在相同准备的基础上增加过氧化氢。然后我们采集皮肤、真皮、盂肱关节和空气（阴性对照）需氧和厌氧培养拭子。我们对分析样本的实验室进行了盲法处理。预先的功效分析确定需要 56 例患者才能看到培养阳性率降低 50%。我们还进行了事后性别分层分析。
在 2017 年 1 月至 2018 年 10 月期间，作者进行了 124 例原发性肩关节置换术，其中我们纳入了 65 例，并对 61 例患者进行了样本采集。两组患者的人口统计学差异无统计学意义。过氧化氢组中三重阳性培养（皮肤、真皮和关节）的患者较少（0%比 19%，P=.024），关节阳性培养的患者也较少（10%比 35%，P=.031）。在我们的亚组分析中，这些差异仅在男性中具有统计学意义。绝大多数阳性培养均为痤疮丙酸杆菌。
尽管需要更大规模的随机研究，但在术前皮肤准备中添加过氧化氢可能是一种降低痤疮丙酸杆菌深层组织污染的低成本、低风险方法，尤其是在男性中。
