Jalali Omid, Best Molly, Wong Alison, Schaeffer Brett, Bauer Brendon, Johnson Lanny
Keck School of Medicine of USC, Los Angeles, California.
Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California.
JB JS Open Access. 2020 Jul 17;5(3). doi: 10.2106/JBJS.OA.19.00078. eCollection 2020 Jul-Sep.
Reducing the rising health-care burden associated with shoulder surgical site infection (SSI) is of paramount importance. The purpose of this study was to investigate the antimicrobial efficacy of protocatechuic acid (PCA) as a topical reagent for surgical skin antisepsis surrounding the shoulder joint.
This was a 2-phase skin-disinfection trial involving the human shoulder. The shoulders of healthy volunteers were randomized to topical treatment with PCA (a 10% concentration of PCA in Phase I [11 subjects] and a 17% concentration in Phase II [12 subjects]), with a control of isopropyl alcohol (IPA) applied to the contralateral shoulder. Mechanical scraping was performed for skin harvest following reagent application, and samples were sent for aerobic and anaerobic culture. Sterilization rates and bacterial counts were determined for each treatment group, and the proportion of subjects with persistent colonization following topical application of PCA was determined using DNA sequencing analysis.
The topical application of 10% PCA was associated with significantly higher aerobic and anaerobic sterilization rates (90.9% and 81.8%, respectively) compared with treatment with IPA (p = 0.0143 and p = 0.0253, respectively). The topical application of 17% PCA was associated with a significantly higher anaerobic sterilization rate (83.3%) and trended toward a significantly higher aerobic sterilization rate (91.7%) compared with treatment with IPA (p = 0.0143 and p = 0.083, respectively). was identified in 18.2% and 0% of subjects following treatment with 10% and 17% PCA, respectively.
The topical application of PCA was associated with a reduction in the bacterial burden of human shoulder skin and demonstrated dose-dependent antimicrobial activity against in young, healthy subjects. Clinical studies in a shoulder surgical population are warranted to determine the potential for application in surgical skin antisepsis to reduce shoulder SSI.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
减轻与肩部手术部位感染（SSI）相关的不断上升的医疗负担至关重要。本研究的目的是调查原儿茶酸（PCA）作为肩关节周围手术皮肤消毒局部试剂的抗菌效果。
这是一项涉及人体肩部的两阶段皮肤消毒试验。健康志愿者的肩部被随机分为接受PCA局部治疗（第一阶段浓度为10%[11名受试者]，第二阶段浓度为17%[12名受试者]），对侧肩部使用异丙醇（IPA）作为对照。试剂应用后进行机械刮擦取皮肤样本，并将样本送去进行需氧和厌氧培养。确定每个治疗组的杀菌率和细菌计数，并使用DNA测序分析确定局部应用PCA后持续定植的受试者比例。
与IPA治疗相比，局部应用10%PCA的需氧和厌氧杀菌率显著更高（分别为90.9%和81.8%）（p分别为0.0143和0.0253）。与IPA治疗相比，局部应用17%PCA的厌氧杀菌率显著更高（83.3%），需氧杀菌率有显著更高的趋势（91.7%）（p分别为0.0143和0.083）。在接受10%和17%PCA治疗的受试者中，分别有18.2%和0%检测到[具体细菌名称未给出]。
PCA局部应用与人体肩部皮肤细菌负担的降低相关，并在年轻健康受试者中显示出对[具体细菌名称未给出]的剂量依赖性抗菌活性。有必要在肩部手术人群中进行临床研究，以确定其在手术皮肤消毒中应用以减少肩部SSI的潜力。
治疗性二级。有关证据水平的完整描述，请参阅作者指南。
