Keck Hospital Department of Orthopaedics, University of Southern California, Los Angeles, CA, USA.
Keck Hospital Department of Orthopaedics, University of Southern California, Los Angeles, CA, USA.
J Shoulder Elbow Surg. 2019 Dec;28(12):2279-2283. doi: 10.1016/j.jse.2019.06.016. Epub 2019 Aug 27.
Cutibacterium (formerly Propionibacterium) acnes persists in the dermis despite standard skin antiseptic agents, prompting some surgeons to use topical antimicrobials such as benzoyl peroxide and clindamycin prior to shoulder arthroplasty surgery. However, the efficacy of these topical agents has not been established.
The upper backs of 12 volunteers were randomized into 4 treatment quadrants: topical benzoyl peroxide, topical clindamycin, combination topical benzoyl peroxide and clindamycin, and a negative control. The corresponding topical agents were applied to each site twice daily for 3 days. A 3-mm dermal punch biopsy specimen was obtained from each site and cultured for 14 days to assess for C acnes growth. Positive cultures were assessed for the hemolytic phenotype. The McNemar test was used to compare the proportion of positive cultures in each group.
C acnes grew in 4 of 12 control sites (33.3%), 1 of 12 benzoyl peroxide sites (8.3%), 2 of 12 clindamycin sites (16.7%), and 2 of 12 combination benzoyl peroxide-clindamycin sites (16.7%). The C acnes hemolytic phenotype was present in 2 of 12 control specimens (16.7%) compared with 0 (0.0%) in the benzoyl peroxide group, 2 of 12 (16.7%) in the clindamycin group, and 2 of 12 (16.7%) in the combination benzoyl peroxide-clindamycin group. There were no statistically significant differences between treatment arms.
The topical application of benzoyl peroxide and clindamycin did not eradicate C acnes in all subjects. The clinical implications of these findings are yet to be determined.
尽管使用了标准皮肤消毒剂，痤疮丙酸杆菌（以前称为丙酸杆菌）仍存在于真皮中，这促使一些外科医生在肩关节置换术前使用局部抗菌药物，如过氧化苯甲酰和克林霉素。然而，这些局部制剂的疗效尚未得到证实。
将 12 名志愿者的上背部随机分为 4 个治疗象限：局部过氧化苯甲酰、局部克林霉素、局部过氧化苯甲酰和克林霉素联合治疗以及阴性对照。将相应的局部制剂每天两次涂抹在每个部位，持续 3 天。从每个部位获得一个 3mm 的皮肤打孔活检标本，并培养 14 天以评估 C 痤疮丙酸杆菌的生长情况。对阳性培养物进行溶血表型评估。使用 McNemar 检验比较每组阳性培养物的比例。
在 12 个对照部位中有 4 个（33.3%）、12 个过氧化苯甲酰部位中有 1 个（8.3%）、12 个克林霉素部位中有 2 个（16.7%）和 12 个联合过氧化苯甲酰-克林霉素部位中有 2 个（16.7%）培养出 C 痤疮丙酸杆菌。在 12 个对照标本中有 2 个（16.7%）存在 C 痤疮丙酸杆菌的溶血表型，而在过氧化苯甲酰组中为 0（0.0%）、克林霉素组中为 2 个（16.7%）、联合过氧化苯甲酰-克林霉素组中为 2 个（16.7%）。各治疗组之间无统计学差异。
局部应用过氧化苯甲酰和克林霉素并不能在所有受试者中根除 C 痤疮丙酸杆菌。这些发现的临床意义尚待确定。
