Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.
Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
Antimicrob Resist Infect Control. 2021 Jan 22;10(1):17. doi: 10.1186/s13756-020-00874-8.
Cutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery. We hypothesized that prolonged skin preparation with an agent that penetrates deeply into the skin would be beneficial. Thus, we compared two classes of antiseptics, each combined with alcohol, each applied with two different contact times.
Using a cross-over arrangement, shoulders of 16 healthy volunteers were treated for 2.5 min (standard) or 30 min (prolonged) with alcohol-based chlorhexidine (CHG-ALC) or alcohol-based povidone-iodine (PVP-I-ALC). Skin sites were sampled before, immediately after, and 3 h after treatment, using a standardized cup-scrub technique.
Aerobic skin flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after 2.5 min application and immediate sampling (reduction factor [RF] 2.55 ± 0.75 vs. 1.94 ± 0.91, p = 0.04), but not after prolonged contact times and 3-h sampling. Coagulase-negative staphylococci were completely eliminated after PVP-I-ALC application, but still recovered from 4 of 32 samples after CHG-ALC application. Anaerobic flora was reduced more effectively by PVP-I-ALC than CHG-ALC after standard (RF 3.96 ± 1.46 vs. 1.74 ± 1.24, p < 0.01) and prolonged (RF 3.14 ± 1.20 vs. 1.38 ± 1.16, p < 0.01) contact times and immediate sampling, but not after 3-h sampling. No adverse events were reported.
PVP-I-ALC showed marginal benefits concerning the aerobic flora, but more substantial benefits over CHG-ALC concerning the anaerobic flora of the shoulder. Standard and prolonged contact times showed superiority for PVP-I-ALC for anaerobic flora at all immediate sampling points, but missed significance at 3-h sampling. The results underscore the need for protection against C. acnes and coagulase-negative staphylococci in orthopaedic surgery. The clinical relevance of these findings, however, should be studied with SSI as an endpoint.
痤疮丙酸杆菌是厌氧皮肤微生物组的一部分，存在于皮肤的深层。该生物体是肩部手术部位感染（SSI）的病原体。我们假设，用一种能深入皮肤的制剂进行长时间的皮肤准备将是有益的。因此，我们比较了两类防腐剂，每类都与酒精结合，每种都采用两种不同的接触时间。
使用交叉排列，16 名健康志愿者的肩部用氯己定（CHG-ALC）或聚维酮碘（PVP-I-ALC）的酒精溶液处理 2.5 分钟（标准）或 30 分钟（延长）。使用标准化的杯式擦洗技术，在处理前、处理后立即和处理后 3 小时对皮肤部位进行采样。
在 2.5 分钟的应用和即时采样时，PVP-I-ALC 比 CHG-ALC 更有效地减少了需氧皮肤菌群（减少因子 [RF] 2.55 ± 0.75 比 1.94 ± 0.91，p = 0.04），但在延长接触时间和 3 小时采样时则不然。凝固酶阴性葡萄球菌在 PVP-I-ALC 应用后完全被清除，但在 CHG-ALC 应用后仍从 32 个样本中的 4 个样本中恢复。标准（RF 3.96 ± 1.46 比 1.74 ± 1.24，p < 0.01）和延长（RF 3.14 ± 1.20 比 1.38 ± 1.16，p < 0.01）接触时间和即时采样时，PVP-I-ALC 比 CHG-ALC 更有效地减少了厌氧菌群，但在 3 小时采样时则不然。未报告不良反应。
PVP-I-ALC 对需氧菌群有轻微益处，但对肩部的厌氧菌群有更显著的益处。标准和延长的接触时间在所有即时采样点都显示出 PVP-I-ALC 对厌氧菌群的优势，但在 3 小时采样时则未达到显著水平。结果强调了在骨科手术中需要预防痤疮丙酸杆菌和凝固酶阴性葡萄球菌。然而，这些发现的临床意义应该以 SSI 为终点进行研究。
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