Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
Harvard Medical School, Boston, MA, USA.
J Shoulder Elbow Surg. 2021 Aug;30(8):1827-1833. doi: 10.1016/j.jse.2021.03.144. Epub 2021 Apr 1.
Prosthetic joint infections (PJIs) following shoulder arthroplasty are a major source of morbidity and are most commonly caused by Cutibacterium acnes, a bacteria found concentrated in the dermis. Skin preparation using hydrogen peroxide has been shown to reduce positive cultures; however, direct application to the dermis has not been investigated. The purpose of this study is to determine whether the application of hydrogen peroxide to the dermis affects the incidence of positive C acnes cultures.
A prospective, randomized controlled trial of patients undergoing primary shoulder arthroplasty by a single fellowship-trained surgeon was performed between February and November 2020. Enrolled patients were randomized to either receive standard skin preparation and antibiotic prophylaxis with or without an additional application of hydrogen peroxide to the dermis following incision. Culture samples were taken from the skin, dermis, glenohumeral joint, and air. Laboratory personnel and patients were blinded to randomization, and all cultures were held for 14 days. Culture positivity rate along with culture site, day of culture positivity, and bacterial abundance of positive cultures were analyzed. Stratified analysis by gender and age of ≤69 years was also performed.
Sixty patients undergoing primary arthroplasty were randomized. The group receiving hydrogen peroxide (n =30) and the control group (n = 30) were similar in age (71.1 ± 7.1 vs. 73.4 ± 9.8; P = .30), body mass index (29.4 ± 5.7 vs. 28.5 ± 6.0; P = .57), gender (P = .64), hand dominance (P = .65), and surgery type (P = .90). The overall rate of at least 1 positive culture was 18%. All positive cultures were C acnes. The positive culture rate in the hydrogen peroxide (20%) and control group were similar (16%; P > .99). There were no positive glenohumeral joint cultures and no wound complications. There was no significance difference in the culture site, day of culture positivity, and bacterial abundance. Stratification analysis by gender and age also demonstrated similar rates of C acnes between study groups.
Standard skin preparation and antibiotic prophylaxis results in an overall low rate of skin and dermis culture positivity. The use of hydrogen peroxide after initial incision did not significantly alter the rate of positive C acnes cultures during shoulder arthroplasty and did not increase wound complications.
肩关节置换术后的人工关节感染（PJI）是发病率的主要来源，最常见的病原体是痤疮丙酸杆菌，一种集中在真皮中的细菌。已经证实，使用过氧化氢进行皮肤准备可以减少阳性培养物；然而，尚未对其直接应用于真皮进行研究。本研究的目的是确定将过氧化氢应用于真皮是否会影响痤疮丙酸杆菌阳性培养物的发生率。
2020 年 2 月至 11 月，对一名 fellowship 培训的外科医生进行的原发性肩关节置换术患者进行了一项前瞻性、随机对照试验。纳入的患者被随机分为两组，一组接受标准皮肤准备和抗生素预防，另一组在切口后加用或不加用过氧化氢处理真皮。从皮肤、真皮、盂肱关节和空气中采集培养样本。实验室人员和患者对随机分组均设盲，所有培养物均培养 14 天。分析培养阳性率以及培养部位、阳性培养物的阳性天数和细菌丰度。还按性别和≤69 岁的年龄进行了分层分析。
共 60 名患者接受了原发性关节置换术，随机分组。接受过氧化氢组（n = 30）和对照组（n = 30）的年龄（71.1 ± 7.1 岁 vs. 73.4 ± 9.8 岁；P =.30）、体重指数（29.4 ± 5.7 岁 vs. 28.5 ± 6.0 岁；P =.57）、性别（P =.64）、利手（P =.65）和手术类型（P =.90）相似。至少有 1 个阳性培养物的总体阳性率为 18%。所有阳性培养物均为痤疮丙酸杆菌。过氧化氢组（20%）和对照组（16%；P＞.99）的阳性培养率相似。无盂肱关节阳性培养物，无伤口并发症。培养部位、阳性培养物的阳性天数和细菌丰度无显著差异。按性别和年龄分层分析也显示研究组之间痤疮丙酸杆菌的阳性率相似。
标准皮肤准备和抗生素预防可导致皮肤和真皮培养物的总体阳性率较低。初始切口后使用过氧化氢并不能显著改变肩关节置换术中痤疮丙酸杆菌阳性培养物的发生率，也不会增加伤口并发症。
