The presence of Cutibacterium acnes on the skin of the shoulder after the use of benzoyl peroxide: a placebo-controlled, double-blinded, randomized trial

Diek, Floor M. van; Pruijn, Nathalie; Spijkers, Karin; Mulder, Bert; Kosse, Nienke M.; Dorrestijn, Oscar

doi:10.1016/j.jse.2019.11.027

Cited by 23 publications

(26 citation statements)

References 41 publications

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“…Two studies investigated the independent effect of peroxide products compared with placebo when applied in the days leading up to the day of culture collection. 12,17 In a pooled analysis of these studies, peroxide significantly diminished C acnes culture positivity (HR 0.174, P = 0.009 [Figure 3]). Two studies investigated the effect of peroxide products compared with CHG when applied in the days leading up to culture collection.…”

Section: Effects Of Peroxide-containing Treatment On C Acnesmentioning

confidence: 99%

“…Three studies used healthy volunteers, 12,16,17 two studies included only arthroplasty patients, 14,25 one study included arthroscopy patients, 15 and one study included both arthroscopy and arthroplasty patients. 26 Cultures were obtained by swab in five studies 14,16,17,25,26 and by dermal punch biopsy in two studies. 15,25 MINORS criteria were used for the two nonrandomized level II studies.…”

Section: Study Selection and Bias Assessmentmentioning

confidence: 99%

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The Efficacy of Peroxide Solutions in Decreasing Cutibacterium acnes Burden Around the Shoulder

Meyer

Lazarides

Hendren

et al. 2021

J Am Acad Orthop Surg

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Background: Cutibacterium acnes is a common pathogen associated with surgical site infection after shoulder surgery; current standard of care products are largely ineffective at reducing C acnes bacterial burden before surgery. The purpose of this systematic metaanalysis was to assess the efficacy of peroxide-containing solutions (PCS) in decreasing the C acnes burden on the shoulder. Methods: This was a systematic review of all level I and II studies investigating the effect of peroxidase-containing products for skin preparation. We extracted data regarding demographics, treatment details and timing, study methodology, and culture positivity. Forest plots were used to determine the pooled efficacy of peroxide solutions versus control. Results: Seven studies with 412 patients were eligible for inclusion. Notable heterogeneity was observed in the manner and timing of peroxide application. Two studies applied PCS at the time of surgery; four studies applied PCS in the 24-to 72-hour period leading up to culture acquisition. Compared with the placebo, peroxide significantly diminished C acnes culture positivity (Hazard Ratio 0.174, P = 0.009). When considering using peroxide-containing products in the period leading up to surgery or at the time of surgery, in addition to standard preparation, the addition of peroxide significantly diminished C acnes culture positivity (HR 0.467, P = 0.004). Owing to study heterogeneity, we could not make notable comparisons based on the timing or duration of benzoyl peroxides application. Conclusions: Despite heterogeneity in study design, pooled results of high-quality data suggest that the addition of PCS can markedly reduce C acnes bioburden. This review was not able to identify the ideal regimen for the utilization of PCS for reduction of C acnes burden. Level of Evidence: Level II C utibacterium (formerly Propionibacterium) acnes is a common Gram-positive bacterium that resides in the pilosebaceous ducts of the skin and is highly concentrated in the axilla. 1 Cutibacterium

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Section: Effects Of Peroxide-containing Treatment On C Acnesmentioning

confidence: 99%

Section: Study Selection and Bias Assessmentmentioning

confidence: 99%

The Efficacy of Peroxide Solutions in Decreasing Cutibacterium acnes Burden Around the Shoulder

Meyer

Lazarides

Hendren

et al. 2021

J Am Acad Orthop Surg

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“…This advice was based on the results of a randomized blinded placebo-controlled study conducted in our clinic to measure the effect of BPO gel on C. acnes decolonization. 3 Between July 2018 and June 2020, another 30 primary SCJ surgeries were performed in our clinic; 26 of these were advised to use BPO gel preoperatively. During the average follow-up period of 14 months (standard deviation 6 months), three early infections occurred (10%).…”

mentioning

confidence: 99%

“…In our BPO gel study, 71% of the participants had positive C. acnes skin cultures. 3 All patients who will have shoulder arthroplasty revision surgery or will have diagnostic biopsies for cultures in our clinic are advised to use BPO preoperatively according to a fixed protocol or are disinfected preoperatively with hydrogen peroxide. 3,4 In case of arthroscopically obtained biopsies for culture, we used a cannula for prevention of skin contact while introducing the biopsy instruments.…”

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confidence: 99%

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Reply: Low-grade Cutibacterium acnes shoulder infections do exist!

Dorrestijn

Pruijn

2020

Shoulder & Elbow

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Cutibacterium acnes invades submicron osteocyte lacuno‐canalicular networks following implant‐associated osteomyelitis

Botros,

de Mesy Bentley,

Schloemann

et al. 2024

Journal Orthopaedic Research

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Cutibacterium acnes, part of normal skin flora, is increasingly recognized as an opportunistic pathogen capable of causing chronic prosthetic joint infections (PJI) associated with total hip and knee arthroplasty. However, there is a paucity of literature examining the pathogenesis of C. acnes during PJI. To study this, we developed an implant‐associated osteomyelitis murine model in which 8–10‐week‐old C57BL6 mice were subjected to transtibial implantation of titanium or stainless‐steel L‐shaped pins contaminated with C. acnes. Postsurgery, mice were killed on Days 14 and 28 for terminal assessments of (1) bacterial load in bone, implant, and internal organs (heart, spleen, kidney, and liver), (2) bone osteolysis (micro‐CT), (3) abscess formation (histology), and (4) systematic electron microscopy (EM). In vitro scanning EM (SEM) confirmed that C. acnes can form biofilms on stainless‐steel and titanium implants. In mice, C. acnes could persist for 28 days in the tibia. Also, we observed C. acnes dissemination to internal organs. C. acnes chronic osteomyelitis revealed markedly reduced bone osteolysis and abscess formation compared to Staphylococcus aureus infections. Importantly, transmission EM (TEM) investigation revealed the presence of C. acnes within canaliculi, demonstrating that C. acnes can invade the osteocyte lacuno‐canalicular networks (OLCN) within bone. Our preliminary pilot study, for the first time, revealed that the OLCN in bone can be a reservoir for C. acnes and potentially provides a novel mechanism of why C. acnes chronic implant‐associated bone infections are difficult to treat.

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The presence of Cutibacterium acnes on the skin of the shoulder after the use of benzoyl peroxide: a placebo-controlled, double-blinded, randomized trial

Cited by 23 publications

References 41 publications

The Efficacy of Peroxide Solutions in Decreasing Cutibacterium acnes Burden Around the Shoulder

The Efficacy of Peroxide Solutions in Decreasing Cutibacterium acnes Burden Around the Shoulder

Reply: Low-grade Cutibacterium acnes shoulder infections do exist!

Cutibacterium acnes invades submicron osteocyte lacuno‐canalicular networks following implant‐associated osteomyelitis

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