Efficacy of Topical Benzoyl Peroxide on the Reduction of
Propionibacterium Acnes During Shoulder Surgery
Study in Journal of Shoulder and Elbow
Surgery evaluates the effect of using the active ingredient in Clearasil to reduce
infection
The article is “
Efficacy of topical benzoyl peroxide on the reduction of Propionibacterium acnes during shoulder surgery” by James R. Sabetta, MD, Vishal P. Rana, BS, Katherine B. Vadasdi, MD, R. Timothy Greene, MD, James G. Cunningham, MD, Seth R. Miller, MD, Paul M. Sethi, MD (doi.org/10.1016/j.jse.2015.04.003). The is published in
Journal of Shoulder and Elbow Surgery, Volume 24, Issue 7 (July 2015), published by
Elsevier; available online on
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Abstract
Greenwich, CT, 30
June, 2015 – A new paper to be
published in The Journal of Shoulder and Elbow
Surgery evaluates the effect that topical
benzoyl peroxide (BPO), with chlorhexidine skin preparation, has on the presence
of Propionibacterium acnes cultured at the time of
shoulder surgery. The authors hypothesized that adding topical BPO, the active
ingredient in Clearasil, to the pre-operative skin preparation would reduce the
number of positive P. acnes cultures identified during surgery.
P. acnes infection is a
significant problem after shoulder surgery. Residual P. acnes is found on the
skin up to 29% of the time immediately after surgical skin preparation and in
70% of dermal biopsy specimens. These residual bacteria may be a source for
infection. Identifying more ideal skin preparation may help reduce the risk of
infection.
Fifty patients undergoing first-time
(arthroscopic) shoulder surgery were treated with topical 5% BPO cream 48 hours
before surgery. After skin preparation, 13 samples per subject were obtained.
These cultures were held for 14 days and 650 culture specimens were obtained.
The skin was positive at the initiation of surgery in 6% of the cases and tissue
samples were positive in 6%. The skin was positive in 10% at the end of surgery.
None of these rates of positive culture were different from the 4% rate observed
with a control swab.
Application of BPO is an effective way to reduce
P. acnes on skin at the beginning and, importantly, at the end of a surgical
procedure. This may result in a lower risk for postoperative infection.
“The setbacks and costs associated with infection
after shoulder surgery are significant,” said senior author Paul M. Sethi,
Clinical Instructor of Orthopedic Surgery Yale University School of Medicine.
“Our first study identified the patients' skin as the source of bacteria that
may cause infection and highlighted the limitations of current skin surgical
preparation. Our team used established dermatologic principles to improve the
way we clean the skin. Dermatologists have used BPO to treat P. acnes on our
face for 50 years. We chose to study this same medicine on the shoulder and the
findings are very exciting. Data demonstrates that we can significantly reduce
potentially dangerous bacteria after skin treatment with BPO. By reducing these
bacteria, we hope to reduce the risk for shoulder infection following
surgery."
