Barton Kristen I, Johnson Roseann M, Miner Todd M, Yang Charlie C, Dennis Douglas A, Jennings Jason M
Colorado Joint Replacement, AdventHealth, Devner, Colorado.
Colorado Joint Replacement, AdventHealth, Devner, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado; Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado; Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee.
J Arthroplasty. 2025 Aug;40(8S1):S3-S8. doi: 10.1016/j.arth.2025.04.029. Epub 2025 Jul 1.
Cutibacterium acnes (C acnes) is of growing concern in periprosthetic joint infections following total hip arthroplasty (THA). The dermal colonization rate of C acnes with various preoperative cleaning protocols in THA has yet to be elucidated. The purpose of the study was to investigate the effect of different preoperative skin cleansing protocols on the colonization rate of the hip in patients undergoing elective THA.
Patients were recruited and randomized into either: 1) standard (STD) surgical preparation (4% chlorhexidine gluconate); or 2) STD + benzoyl peroxide (BPO) gel (four applications of 5% BPO gel). On the morning of the biopsy collection, a final application of 5% BPO gel was applied. Intraoperatively, all patients had their skin prepped with STD preparation. There were six 3-mm punch skin biopsies performed per patient for both an anterior-based hypothetical incision and a more lateral/posterior incision. Samples were cultured and held for 14 days.
Of the biopsies, 11% had a positive culture. There were 38% of the patients in the STD group and 41% of the patients in the BPO group who had a positive culture (P = 0.61). There were 17% of the patients in the STD group and 20% of the patients in the BPO group who had a positive culture for C acnes (P = 0.51). C acnes was more commonly cultured in both the STD and BPO groups as compared to Staphylococcus species and Bacillus species. There were no differences between positive culture biopsies between anterior or lateral sampling locations (P = 0.62 STD group and P = 0.71 BPO group).
There was a high rate of patients that demonstrated C acnes colonization prior to THA. There was no difference in positive culture rate with anterior or lateral sample locations. Preoperative surgical preparation was not effective at decreasing the burden of C acnes from the surgical site prior to THA, and different skin preparations should be considered.
痤疮丙酸杆菌（C型痤疮杆菌）在全髋关节置换术（THA）后假体周围关节感染中越来越受到关注。THA中采用各种术前清洁方案时C型痤疮杆菌的皮肤定植率尚未阐明。本研究的目的是调查不同术前皮肤清洁方案对择期THA患者髋部定植率的影响。
招募患者并随机分为：1）标准（STD）手术准备（4%葡萄糖酸氯己定）；或2）STD + 过氧化苯甲酰（BPO）凝胶（5% BPO凝胶涂抹四次）。在活检采集当天上午，再次涂抹一次5% BPO凝胶。术中，所有患者均采用STD准备进行皮肤准备。每位患者针对基于前方的假设切口和更外侧/后方的切口各进行六次3毫米的皮肤穿刺活检。样本进行培养并保存14天。
活检样本中，11%培养结果为阳性。STD组中有38%的患者培养结果为阳性，BPO组中有41%的患者培养结果为阳性（P = 0.61）。STD组中有17%的患者C型痤疮杆菌培养结果为阳性，BPO组中有20%的患者C型痤疮杆菌培养结果为阳性（P = 0.51）。与葡萄球菌属和芽孢杆菌属相比，STD组和BPO组中C型痤疮杆菌的培养更为常见。前方或外侧采样部位的培养阳性活检样本之间无差异（STD组P = 0.62，BPO组P = 0.71）。
THA术前有很高比例的患者显示存在C型痤疮杆菌定植。前方或外侧样本部位的培养阳性率无差异。术前手术准备在THA术前未能有效降低手术部位C型痤疮杆菌的负荷，应考虑采用不同的皮肤准备方法。
