Techniques for Decreasing Bacterial Load for Open Shoulder Surgery

Author:

Panther Eric J.1ORCID,Hao Kevin A.1ORCID,Wright Jonathan O.2ORCID,Schoch Jennifer J.3ORCID,Ritter Alaina S.4ORCID,King Joseph J.2ORCID,Wright Thomas W.2ORCID,Schoch Bradley S.5ORCID

Affiliation:

1. College of Medicine, University of Florida, Gainesville, Florida

2. Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida

3. Department of Dermatology, University of Florida, Gainesville, Florida

4. Department of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida

5. Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida

Abstract

» Benzoyl peroxide (BPO) 5% has been shown to reduce Cutibacterium acnes load on the skin. BPO 5% with miconazole nitrate (MN) 2% may be beneficial, whereas BPO 5% with clindamycin cream 1% to 1.2% does not seem to have additive effects when compared with BPO 5% alone. Chlorhexidine gluconate solutions reduce the total bacterial load on the skin, but do not seem to have a significant effect on C. acnes.» ChloraPrep seems to be the best surgical skin preparation to decrease overall positive skin cultures. Preincisional hydrogen peroxide 3% application has been shown to be a cost-effective practice to inhibit growth of C. acnes. Vancomycin powder before deltopectoral interval closure has antimicrobial effects against C. acnes and is a cost-effective practice. Finally, Bactisure surgical lavage is protective against the formation of biofilms.» IV cefazolin has been shown to be more effective for shoulder arthroplasty infection prophylaxis than antibiotic alternatives such as vancomycin. Thus, patients with a questionable history of penicillin allergy should undergo additional testing.» For shoulder surgery infection prophylaxis, we recommend the use of BPO 5% cream for 5 days preoperatively with chlorhexidine wipes the night before and the morning of surgery. IV cefazolin should be administered perioperatively, and patients with a questionable history of penicillin allergy should be tested. Surgeons should consider preincisional application of hydrogen peroxide 3% for 5 minutes, followed by standard ChloraPrep preparation. Normal saline should be used for preclosure lavage. Finally, application of vancomycin powder deep to the deltopectoral interval closure should be considered.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Orthopedics and Sports Medicine,Surgery

Cited by 3 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Vancomycin Soaking to Reduce Intraoperative Contamination by Cutibacterium acnes During the Latarjet Procedure;The American Journal of Sports Medicine;2024-08-23

2. The shoulder microbiome: a systematic review and meta analysis;JSES Reviews, Reports, and Techniques;2024-07

3. Antibiotic therapy of acne and antibiotic resistance: State of the art;Russian Journal of Skin and Venereal Diseases;2023-11-17

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