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International Orthopaedics

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01-03-2020 | Joint Infection | Original Paper

While home chlorhexidine washes prior to shoulder surgery lower skin loads of most bacteria, they are not effective against Cutibacterium (Propionibacterium)

Authors: Frederick A. Matsen, Anastasia J. Whitson, Jason E. Hsu

Published in: International Orthopaedics | Issue 3/2020

Abstract

Purpose

Chlorhexidine showers prior to shoulder arthroplasty are commonly recommended by surgeons to lower the risk of periprosthetic infection; however, the effectiveness of these washes in eliminating bacteria from the skin of the shoulder has not been thoroughly evaluated. The objective of this study was to determine the degree to which pre-operative chlorhexidine washes effectively eliminate bacteria from the epidermal skin surface and from the dermis freshly incised during shoulder arthroplasty.

Methods

Around 66 patients undergoing primary shoulder arthroplasty were instructed to shower with chlorhexidine before surgery. Each patient had three skin swabs: (1) the epidermis at a pre-operative clinic appointment, (2) the epidermis at surgery after home chlorhexidine showers but prior to skin preparation, and (3) the dermis after incision of the prepared skin. The bacterial loads of Cutibacterium and other bacterial types from each swab were compared to determine whether the showers were effective in altering the bacterial loads.

Results

Chlorhexidine washes were effective in reducing the skin load of other bacterial species (p < 0.005), but they did not decrease the skin load of Cutibacterium (p = 0.585).

Conclusions

Pre-operative skin showers with chlorhexidine were not effective in reducing the load of Cutibacterium on the skin of patients having shoulder arthroplasty. Since Cutibacterium is responsible for the highest percentage of shoulder periprosthetic infections, research is needed to identify more effective means of removing these bacteria from the surgical field.

Grice EA, Kong HH, Conlan S, Deming CB, Davis J, Young AC, Program NCS, Bouffard GG, Blakesley RW, Murray PR, Green ED, Turner ML, Segre JA (2009) Topographical and temporal diversity of the human skin microbiome. Science 324:1190–1192. https://doi.org/10.1126/science.1171700 CrossRefPubMedPubMedCentral

Grice EA, Segre JA (2011) The skin microbiome. Nat Rev Microbiol 9:244–253. https://doi.org/10.1038/nrmicro2537 CrossRefPubMedPubMedCentral

Nelson GN, Davis DE, Namdari S (2016) Outcomes in the treatment of periprosthetic joint infection after shoulder arthroplasty: a systematic review. J Shoulder Elb Surg 25:1337–1345. https://doi.org/10.1016/j.jse.2015.11.064 CrossRef

Hsu JE, Bumgarner RE, Matsen FA 3rd (2016) Propionibacterium in shoulder arthroplasty: what we think we know today. J Bone Joint Surg Am 98:597–606. https://doi.org/10.2106/JBJS.15.00568 CrossRefPubMed

Pottinger P, Butler-Wu S, Neradilek MB, Merritt A, Bertelsen A, Jette JL, Warme WJ, Matsen FA 3rd (2012) Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening. J Bone Joint Surg Am 94:2075–2083. https://doi.org/10.2106/JBJS.K.00861 CrossRefPubMed

MacNiven I, Hsu JE, Neradilek MB, Matsen FAI (2018) Preoperative skin-surface cultures can help to predict the presence of Propionibacterium in shoulder arthroplasty wounds. JBJS Open Access 3:e0052. https://doi.org/10.2106/jbjs.Oa.17.00052 CrossRefPubMedPubMedCentral

Hsu JE, Neradilek MB, Russ SM, Matsen FA 3rd (2018) Preoperative skin cultures are predictive of Propionibacterium load in deep cultures obtained at revision shoulder arthroplasty. J Shoulder Elb Surg 27:765–770. https://doi.org/10.1016/j.jse.2018.01.021 CrossRef

Falconer TM, Baba M, Kruse LM, Dorrestijn O, Donaldson MJ, Smith MM, Figtree MC, Hudson BJ, Cass B, Young AA (2016) Contamination of the surgical field with Propionibacterium acnes in primary shoulder arthroplasty. J Bone Joint Surg Am 98:1722–1728. https://doi.org/10.2106/JBJS.15.01133 CrossRefPubMed

Lee MJ, Pottinger PS, Butler-Wu S, Bumgarner RE, Russ SM, Matsen FA 3rd (2014) Propionibacterium persists in the skin despite standard surgical preparation. J Bone Joint Surg Am 96:1447–1450. https://doi.org/10.2106/JBJS.M.01474 CrossRefPubMed

10.

Namdari S, Nicholson T, Parvizi J, Ramsey M (2017) Preoperative doxycycline does not decolonize Propionibacterium acnes from the skin of the shoulder: a randomized controlled trial. J Shoulder Elb Surg 26:1495–1499. https://doi.org/10.1016/j.jse.2017.06.039 CrossRef

11.

Rao AJ, Chalmers PN, Cvetanovich GL, O'Brien MC, Newgren JM, Cole BJ, Verma NN, Nicholson GP, Romeo AA (2018) Preoperative doxycycline does not reduce Propionibacterium acnes in shoulder arthroplasty. J Bone Joint Surg Am 100:958–964. https://doi.org/10.2106/JBJS.17.00584 CrossRefPubMed

12.

Matsen FA 3rd, Russ SM, Bertelsen A, Butler-Wu S, Pottinger PS (2015) Propionibacterium can be isolated from deep cultures obtained at primary arthroplasty despite intravenous antimicrobial prophylaxis. J Shoulder Elb Surg 24:844–847. https://doi.org/10.1016/j.jse.2014.10.016 CrossRef

13.

Koh CK, Marsh JP, Drinkovic D, Walker CG, Poon PC (2016) Propionibacterium acnes in primary shoulder arthroplasty: rates of colonization, patient risk factors, and efficacy of perioperative prophylaxis. J Shoulder Elb Surg 25:846–852. https://doi.org/10.1016/j.jse.2015.09.033 CrossRef

14.

Phadnis J, Gordon D, Krishnan J, Bain GI (2016) Frequent isolation of Propionibacterium acnes from the shoulder dermis despite skin preparation and prophylactic antibiotics. J Shoulder Elbow Surg 25:304–310. https://doi.org/10.1016/j.jse.2015.08.002 CrossRefPubMed

15.

Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL (2009) Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am 91:1949–1953. https://doi.org/10.2106/JBJS.H.00768 CrossRefPubMed

16.

Murray MR, Saltzman MD, Gryzlo SM, Terry MA, Woodward CC, Nuber GW (2011) Efficacy of preoperative home use of 2% chlorhexidine gluconate cloth before shoulder surgery. J Shoulder Elb Surg 20:928–933. https://doi.org/10.1016/j.jse.2011.02.018 CrossRef

17.

Butler-Wu SM, Burns EM, Pottinger PS, Magaret AS, Rakeman JL, Matsen FA 3rd, Cookson BT (2011) Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol 49:2490–2495. https://doi.org/10.1128/JCM.00450-11 CrossRefPubMedPubMedCentral

18.

Matsen FA, Butler-Wu S, Carofino BC, Jette J, Bertelsen A, Bumgarner R (2013) Origin of Propionibacterium in surgical wounds and evidence-based approach for culturing Propionibacterium from surgical sites. J Bone Joint Surg Am 95:e1811–e1817. https://doi.org/10.2106/JBJS.L.01733 CrossRefPubMed

19.

Ahsan ZS, Somerson JS, Matsen FA 3rd (2017) Characterizing the Propionibacterium load in revision shoulder arthroplasty: a study of 137 culture-positive cases. J Bone Joint Surg Am 99:150–154. https://doi.org/10.2106/JBJS.16.00422 CrossRefPubMed

20.

Dizay HH, Lau DG, Nottage WM (2017) Benzoyl peroxide and clindamycin topical skin preparation decreases Propionibacterium acnes colonization in shoulder arthroscopy. J Shoulder Elbow Surg 26:1190–1195. https://doi.org/10.1016/j.jse.2017.03.003 CrossRefPubMed

21.

Kolakowski L, Lai JK, Duvall GT, Jauregui JJ, Dubina AG, Jones DL, Williams KM, Hasan SA, Henn RF 3rd, Gilotra MN (2018) Neer award 2018: benzoyl peroxide effectively decreases preoperative Cutibacterium acnes shoulder burden: a prospective randomized controlled trial. J Shoulder Elb Surg 27:1539–1544. https://doi.org/10.1016/j.jse.2018.06.012 CrossRef

22.

Sabetta JR, Rana VP, Vadasdi KB, Greene RT, Cunningham JG, Miller SR, Sethi PM (2015) Efficacy of topical benzoyl peroxide on the reduction of Propionibacterium acnes during shoulder surgery. J Shoulder Elb Surg 24:995–1004. https://doi.org/10.1016/j.jse.2015.04.003 CrossRef

23.

Scheer VM, Bergman Jungestrom M, Lerm M, Serrander L, Kalen A (2018) Topical benzoyl peroxide application on the shoulder reduces Propionibacterium acnes: a randomized study. J Shoulder Elb Surg 27:957–961. https://doi.org/10.1016/j.jse.2018.02.038 CrossRef

Title: While home chlorhexidine washes prior to shoulder surgery lower skin loads of most bacteria, they are not effective against Cutibacterium (Propionibacterium)
Authors: Frederick A. Matsen
Anastasia J. Whitson
Jason E. Hsu
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keyword: Joint Infection
Published in: International Orthopaedics / Issue 3/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04477-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

While home chlorhexidine washes prior to shoulder surgery lower skin loads of most bacteria, they are not effective against Cutibacterium (Propionibacterium)

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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