Propionibacterium Persists in the Skin Despite Standard Surgical Preparation

Abstract

Propionibacteria are increasingly discussed as having an association with infection, implant failure, and degenerative disease. This study confirms the possibility that the dermal layer of skin may be the source of the bacteria.

Two cases of non‐prosthetic bone and joint infection due to Propionibacterium acnes

“…lumbar puncture) have been described. 6,7 In our second case, no obvious skin breakdown was found. The patient had undergone two surgical procedures several years earlier.…”

Efficacy of topical benzoyl peroxide on the reduction of Propionibacterium acnes during shoulder surgery

“…13 The high rate of residual bacteria left on the epidermis and dermis after surgical skin preparation may be the source of infection in susceptible patients, particularly those having procedures with a surgical implant. 12,16,20,21 These studies suggest a need for a more ideal surgical skin preparation to address the residual bacteria and potentially to reduce the risk for SSI.…”

“…Numerous methods for reducing surgical site infection (SSI) have been studied, with a particular interest in chlorhexidine as the most ideal skin preparation. 2,9,12,16,20,21 Chlorhexidine gluconate combined with isopropyl alcohol (ChloraPrep; Care Fusion Corp., San Diego, CA, USA) has been suggested to be the most effective surgical skin preparation for shoulder surgery, but this effect is not specific for P. acnes. 12,20,21 P. acnes may persist on the skin from 7% to 29% of the time immediately after skin preparation.…”

“…2,9,12,16,20,21 Chlorhexidine gluconate combined with isopropyl alcohol (ChloraPrep; Care Fusion Corp., San Diego, CA, USA) has been suggested to be the most effective surgical skin preparation for shoulder surgery, but this effect is not specific for P. acnes. 12,20,21 P. acnes may persist on the skin from 7% to 29% of the time immediately after skin preparation. 10,17,21 The chance of finding these bacteria at the end of the surgical procedure may increase to 41% to 63%.…”

“…22 Furthermore, P. acnes was identified in 70% of subjects undergoing a dermal biopsy after skin preparation with ChloraPrep. 12 These residual bacteria may be present because current skin preparations do not sufficiently penetrate the dermal layer of skin, whereas P. acnes resides in the sebaceous glands. 16 Alternatively, P. acnes may reside in the joint of the normal shoulder and may even be a precursor pathologic organism to development of arthritis.…”