Nathanael Heckmann1, Lakshmanan Sivasundaram2, K Soraya Heidari1, Alexander E Weber3, Erik N Mayer1, Reza Omid1, C Thomas Vangsness1, George F Hatch1. 1. Section of Sports Medicine, Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A. 2. Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, U.S.A. 3. Section of Sports Medicine, Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.. Electronic address: weberae@usc.edu.
Abstract
PURPOSE: To investigate the efficacy of various skin preparations at eradicating Propionibacterium acnes in the dermal layer of the skin. METHODS: Twelve healthy volunteers consented to participate in this study. Each subject's upper back was prepped using 4 different techniques: an isopropyl alcohol control, chlorhexidine gluconate paint, chlorhexidine gluconate plus a mechanical scrub, and a high-concentration chlorhexidine gluconate plus a mechanical scrub. A 3-mm dermal punch biopsy specimen was obtained at each preparation site. The 4 punch biopsy specimens were cultured for 14 days to assess for P. acnes growth. A Fisher's exact test was used to compare the proportion of positive cultures in each group and across biopsy sites. A Skillings-Mack test was used to compare the degree of culture positivity between the treatment arms. RESULTS: There were no reported complications in any of our subjects. P. acnes grew in 7 of the 12 control sites, 5 of the 12 chlorhexidine gluconate sites, 6 of the 12 chlorhexidine plus mechanical scrub sites, and 6 of the 12 high-concentration chlorhexidine gluconate plus mechanical scrub sites. There were no statistically significant differences between any of the treatment arms (P = .820). CONCLUSIONS: P. acnes persisted despite a variety of clinically relevant skin antisepsis preparations and techniques. LEVEL OF EVIDENCE: Level II, prospective comparative study.
PURPOSE: To investigate the efficacy of various skin preparations at eradicating Propionibacterium acnes in the dermal layer of the skin. METHODS: Twelve healthy volunteers consented to participate in this study. Each subject's upper back was prepped using 4 different techniques: an isopropyl alcohol control, chlorhexidine gluconate paint, chlorhexidine gluconate plus a mechanical scrub, and a high-concentration chlorhexidine gluconate plus a mechanical scrub. A 3-mm dermal punch biopsy specimen was obtained at each preparation site. The 4 punch biopsy specimens were cultured for 14 days to assess for P. acnes growth. A Fisher's exact test was used to compare the proportion of positive cultures in each group and across biopsy sites. A Skillings-Mack test was used to compare the degree of culture positivity between the treatment arms. RESULTS: There were no reported complications in any of our subjects. P. acnes grew in 7 of the 12 control sites, 5 of the 12 chlorhexidine gluconate sites, 6 of the 12 chlorhexidine plus mechanical scrub sites, and 6 of the 12 high-concentration chlorhexidine gluconate plus mechanical scrub sites. There were no statistically significant differences between any of the treatment arms (P = .820). CONCLUSIONS: P. acnes persisted despite a variety of clinically relevant skin antisepsis preparations and techniques. LEVEL OF EVIDENCE: Level II, prospective comparative study.
Authors: Steven M Maurer; Laura Kursawe; Stefan Rahm; Julia Prinz; Annelies S Zinkernagel; Annette Moter; Stefan P Kuster; Reinhard Zbinden; Patrick O Zingg; Yvonne Achermann Journal: Antimicrob Resist Infect Control Date: 2021-02-01 Impact factor: 4.887