Topical acne cream prior to shoulder surgery may reduce infection risk
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Application of a topical acne cream 7 days prior to open shoulder surgery may reduce the intraoperative Cutibacterium acnes load in patients, according to study results.
Researchers randomly assigned 60 patients undergoing primary open shoulder surgery to receive either a 7-day preoperative application of a commercial acne cream of a combination of benzoyl peroxide and miconazole nitrate (Acne Creme Plus Widmer, Louis Widmer AG; n=30) or no cream (n=30). Researchers sampled the superficial skin of the shoulder at enrollment and before incision. Researchers also collected deep subcutaneous and capsular shoulder samples during surgery. Researchers considered the proportion of positive C. acnes results in the perioperative samples stratified between the two groups and differing between individuals with a previously detected C. acnes skin colonization and the whole study group as the primary outcome parameter, while the presence of adverse events attributed to the acne cream was considered the secondary outcome parameter.
Results showed 18 patients in the intervention group and 19 patients in the control group had the presence of C. acnes on the skin at baseline. Among patients with C. acnes skin colonization, researchers found a significant reduction in the overall number of positive intraoperative samples among patients who received the acne cream vs. the control group. Researchers noted no patients in the intervention group had C. acnes colonization in the capsular samples vs. four positive capsular samples in the control group.
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Ines Unterfrauner, MD, and colleagues continue the effort to reduce the chance of developing a C. acnes infection after shoulder surgery. The authors proposed a 7-day course of topical cream (benzoyl peroxide and miconazole) and found C. acnes dropped by 56% in the intervention group compared to 16% in the control group. The intervention group had no capsular specimens that grew C. acnes vs. 17% of the control group that grew the same bacteria.
In 2015, our group first described using topical benzoyl peroxide to address C. acnes. This Swiss study adds to the growing body of literature that suggests the use of a topical antibacterial agent applied in the days preceding surgery to penetrate the subdermal tissue will reduce the deep dermal layers of C. acnes.
Surgeons routinely recognize that C. acnes is a (if not the) major pathogen in following shoulder surgery. Utilization of topical benzoyl peroxide or intraoperative hydrogen peroxide are important strategies to decolonize and sterilize the wound from commensal C. acnes.
I am optimistic strategies suggested by Unterfrauner and colleagues will reduce the actual rate of infection.
Reference:
Sabetta JR, et al. J Shoulder Elbow Surg. 2015;doi:10.1016/j.jse.2015.04.003.
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