Background
Cutibacterium acnes
is the primary cause of shoulder surgery infections, but the predisposition to larger skin counts and potentially higher risk for postoperative infection remains unclear. This study aimed to quantify risk factors influencing endogenous
C. acnes
burden and to compare counts among 4 shoulder sites.
Methods
C. acnes
counts were quantified via a detergent scrub technique for 173 participants. Bivariate and multivariable stepwise linear regression statistical analyses were used to investigate the association of sex, age, ethnicity, degree of hirsutism, diabetes, smoking status, body mass index, and location with counts. A separate Wilcoxon rank-sum test was performed analyzing counts of East/Southeast Asians vs. all other ethnicities.
Results
Sex, age, degree of hirsutism, diabetes, smoking status, and body mass index were included in the multivariable stepwise linear regression analysis. The multiple regression analysis isolated individuals <40 years with the highest burden (
P
= .001). Males had a 191% increase in
C. acnes
counts compared with females (
P
= .001). Increased hirsutism was further indicated to be a risk factor for the male sex although not in a dose-dependent manner (
P
= .027). Wilcoxon rank-sum test results found that East/Southeast Asians had the lowest load (
P
= .019), although not significant in the multivariate model.
Conclusion
Surgical site
C. acnes
infections occur more frequently in younger males, and males <40 years with shoulder-specific hirsutism have the highest preoperative burden. East/Southeast Asians have lower raw counts of
C. acnes
compared with other ethnicities that may be related to less hirsutism.
Background
Cutibacterium acnes
is the primary cause of shoulder surgery infections, but the predisposition to larger skin counts and potentially higher risk for postoperative infection remains unclear. This study aimed to quantify risk factors influencing endogenous
C. acnes
burden and to compare counts among 4 shoulder sites.
Methods
C. acnes
counts were quantified via a detergent scrub technique for 173 participants. Bivariate and multivariable stepwise linear regression statistical analyses were used to investigate the association of sex, age, ethnicity, degree of hirsutism, diabetes, smoking status, body mass index, and location with counts. A separate Wilcoxon rank-sum test was performed analyzing counts of East/Southeast Asians vs. all other ethnicities.
Results
Sex, age, degree of hirsutism, diabetes, smoking status, and body mass index were included in the multivariable stepwise linear regression analysis. The multiple regression analysis isolated individuals <40 years with the highest burden (
P
= .001). Males had a 191% increase in
C. acnes
counts compared with females (
P
= .001). Increased hirsutism was further indicated to be a risk factor for the male sex although not in a dose-dependent manner (
P
= .027). Wilcoxon rank-sum test results found that East/Southeast Asians had the lowest load (
P
= .019), although not significant in the multivariate model.
Conclusion
Surgical site
C. acnes
infections occur more frequently in younger males, and males <40 years with shoulder-specific hirsutism have the highest preoperative burden. East/Southeast Asians have lower raw counts of
C. acnes
compared with other ethnicities that may be related to less hirsutism.
“…Nineteen studies have been included in this review. 25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] (supplementary Appendix 4). The total number of participants was 957, with a mean age of 59 years (range: 17-89) and 64% were male (Table 1).…”
Section: Resultsmentioning
confidence: 99%
“…The total number of participants was 957, with a mean age of 59 years (range: 17-89) and 64% were male (Table 1). Four studies used participants undergoing shoulder arthroplasty, [27][28][29][30] four studies used patients undergoing shoulder arthroscopy, [31][32][33][34] one study was conducted using patients undergoing surgery for proximal humerus fracture, 35 one study used patients undergoing arthroplasty and arthroscopy, 36 six studies used healthy volunteers, [37][38][39][40][41][42] two studies recruited patients undergoing open shoulder surgery 43,44 and one study was in vitro. 25…”
Section: Resultsmentioning
confidence: 99%
“…Nine studies evaluated skin preparation methods used as home treatment prior to shoulder surgery. Eight assessed the effectiveness of benzoyl peroxide (BPO) 28,31,32,36,37,[40][41][42] and one CHG alone. 30 Of the eight BPO studies, two assessed the effectiveness of BPO alone, 32,37 three compared it against CHG, 28,36,41 one study compared it against BPO/clindamycin and clindamycin alone, 40 one study compared it with placebo 42 and one reported the combination of BPO and clindamycin without control.…”
Background Cutibacterium acnes ( C. acnes) is the most common pathogen responsible for post-operative shoulder infections. The purpose of this study was to evaluate the effectiveness of skin preparation methods against C. acnes in shoulder surgery. Methods A systematic review was conducted evaluating the effectiveness of skin preparation methods in the reduction of C. acnes in patients undergoing shoulder surgery. Outcomes were assessed based on the effectiveness of the method used; side effects and cost were also analysed. Results Of the 19 included studies, 9 evaluated pre-surgical home treatments: 8 assessed benzoyl peroxide (BPO) and 6 concluded it is effective in reducing C. acnes. Nine studies assessed surgical skin preparation and concluded that Chlorhexidine gluconate (CHG) was not effective; in contrast hydrogen peroxide reduced C. acnes. Finally, one study evaluated an aseptic protocol using CHG and concluded that it was not effective. Conclusions It was demonstrated that BPO as home treatment is effective in reducing C. acnes load on skin ; it rarely causes side effects and is also cost-effective. This study highlights non-effectiveness of CHG. There was some evidence that the addition of hydrogen peroxide could have a positive effect in the reduction of C. acnes skin load; however, more studies are required.
“…The 2018 International Consensus Meeting does not recommend for or against topical treatment, although 3% hydrogen peroxide or 5% benzoyl peroxide have been shown to decrease the burden of Cutibacterium acnes on the skin. 48 , 59 , 60 Currently, the perioperative antibiotic of choice in shoulder arthroplasty is Cefazolin, which should be applied intravenously 30–60 minutes prior to incision in a dose of 2 grams. The 2018 International Consensus Meeting concluded that postoperative antibiotics are not necessary, but that, if administered, they should not be continued beyond 24 hours postoperatively.…”
Early reported complication rates with the Grammont-type reverse shoulder arthroplasty (RSA) were very high, up to 24%. A ‘problem’ is defined as an intraoperative or postoperative event that is not likely to affect the patient’s final outcome, such as intraoperative cement extravasation and radiographic changes. A ‘complication’ is defined as an intraoperative or postoperative event that is likely to affect the patient’s final outcome, including infection, neurologic injury and intrathoracic central glenoid screw placement. Radiographic changes around the glenoid or humeral components of the RSA are very frequently observed and described in the literature. High complication rates related to the Grammont RSA design led to development of non-Grammont designs which led to a dramatic fall in the majority of complications. The percentage of radiological changes after RSA is not negligible and remains unsolved, despite a decrease in its occurrence in the last decade. However, such changes should be now considered as simple problems because they rarely have a negative influence on the patient’s final outcome, and their prevalence has dramatically decreased. With further changes in indications and designs for RSA, it is crucial to accurately track the rates and types of complications to justify its new designs and increased indications. Cite this article: EFORT Open Rev 2021;6:1109-1121. DOI: 10.1302/2058-5241.6.210040
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