Simon B M MacLean1, Joideep Phadnis2, Chi M Ling1, Gregory I Bain1. 1. Department of Orthopaedics and Trauma, Flinders University, Adelaide, SA, Australia. 2. Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, Brighton, UK.
Abstract
BACKGROUND: Chlorhexidine as a skin surface antiseptic has been shown to be ineffective with respect to reducing Proprionibacterium acnes colonization within the dermis. The purpose of the present study was to determine whether the application of aqueous chlorhexidine solution to the dermal layer decreased P. acnes colonization during open shoulder surgery. METHODS: The present study enrolled 50 patients who were undergoing open shoulder surgery. Patients received standard antimicrobial preparation. Three dermal swabs were taken from each patient: swab 1 following skin incision; swab taken 2 minutes to 5 minutes post-application of aqueous chlorhexidine to the dermis; and swab 3 taken 60 minutes post-application. RESULTS: Mean age was 57.5 years (22 males, 28 females). There were 21 patients (42%) with P. acnes present on any dermal swab. There were significantly more P. acnes positive cultures identified at swab 3 compared to swab 1 (p = 0.043). In nine patients with positive P. acnes at cultures swab 1, eight also isolated P. acnes after at swabs 2 or 3. Males were significantly more likely to have P. acnes on any swab (p < 0.001). Positive P. acnes cultures were significantly more common in patients ≤50 years (p < .001). None of the patients had any clinical signs of infection at a minimum of 1 year following surgery. CONCLUSIONS: Dermal application of aqueous chlorhexidine during open shoulder surgery fails to eradicate or reduce P. acnes on deep cultures.
BACKGROUND: Chlorhexidine as a skin surface antiseptic has been shown to be ineffective with respect to reducing Proprionibacterium acnes colonization within the dermis. The purpose of the present study was to determine whether the application of aqueous chlorhexidine solution to the dermal layer decreased P. acnes colonization during open shoulder surgery. METHODS: The present study enrolled 50 patients who were undergoing open shoulder surgery. Patients received standard antimicrobial preparation. Three dermal swabs were taken from each patient: swab 1 following skin incision; swab taken 2 minutes to 5 minutes post-application of aqueous chlorhexidine to the dermis; and swab 3 taken 60 minutes post-application. RESULTS: Mean age was 57.5 years (22 males, 28 females). There were 21 patients (42%) with P. acnes present on any dermal swab. There were significantly more P. acnes positive cultures identified at swab 3 compared to swab 1 (p = 0.043). In nine patients with positive P. acnes at cultures swab 1, eight also isolated P. acnes after at swabs 2 or 3. Males were significantly more likely to have P. acnes on any swab (p < 0.001). Positive P. acnes cultures were significantly more common in patients ≤50 years (p < .001). None of the patients had any clinical signs of infection at a minimum of 1 year following surgery. CONCLUSIONS: Dermal application of aqueous chlorhexidine during open shoulder surgery fails to eradicate or reduce P. acnes on deep cultures.
Authors: Christopher C Dodson; Edward V Craig; Frank A Cordasco; David M Dines; Joshua S Dines; Edward Dicarlo; Barry D Brause; Russell F Warren Journal: J Shoulder Elbow Surg Date: 2009-11-01 Impact factor: 3.019
Authors: Susan M Butler-Wu; Erica M Burns; Paul S Pottinger; Amalia S Magaret; Jennifer L Rakeman; Frederick A Matsen; Brad T Cookson Journal: J Clin Microbiol Date: 2011-05-04 Impact factor: 5.948
Authors: Peter J Millett; Yi-Meng Yen; Connie S Price; Marilee P Horan; Olivier A van der Meijden; Florian Elser Journal: Clin Orthop Relat Res Date: 2011-01-15 Impact factor: 4.176
Authors: Rabih O Darouiche; Matthew J Wall; Kamal M F Itani; Mary F Otterson; Alexandra L Webb; Matthew M Carrick; Harold J Miller; Samir S Awad; Cynthia T Crosby; Michael C Mosier; Atef Alsharif; David H Berger Journal: N Engl J Med Date: 2010-01-07 Impact factor: 91.245
Authors: Matthew D Saltzman; Gordon W Nuber; Stephen M Gryzlo; Geoffrey S Marecek; Jason L Koh Journal: J Bone Joint Surg Am Date: 2009-08 Impact factor: 5.284
Authors: Stephen G Thon; Adam J Seidl; Jonathan T Bravman; Eric C McCarty; Felix H Savoie; Rachel M Frank Journal: Curr Rev Musculoskelet Med Date: 2020-02