Evaluation of the effectiveness of skin preparation methods for the reduction of <i>Cutibacterium acnes</i> (formerly <i>Propionibacterium acnes</i>) in shoulder surgery: a systematic review.

Abstract

<i>Cutibacterium acnes</i> (<i>C. acnes</i>) is the most common pathogen responsible for post-operative shoulder infections. The purpose of this study was to evaluate the effectiveness of skin preparation methods against <i>C. acnes</i> in shoulder surgery. A systematic review was conducted evaluating the effectiveness of skin preparation methods in the reduction of <i>C. acnes</i> in patients undergoing shoulder surgery. Outcomes were assessed based on the effectiveness of the method used; side effects and cost were also analysed. Of the 19 included studies, 9 evaluated pre-surgical home treatments: 8 assessed benzoyl peroxide (BPO) and 6 concluded it is effective in reducing <i>C. acnes.</i> Nine studies assessed surgical skin preparation and concluded that Chlorhexidine gluconate (CHG) was not effective; in contrast hydrogen peroxide reduced <i>C. acnes</i>. Finally, one study evaluated an aseptic protocol using CHG and concluded that it was not effective. It was demonstrated that BPO as home treatment is effective in reducing <i>C. acnes</i> load on skin<i>;</i> it rarely causes side effects and is also cost-effective. This study highlights non-effectiveness of CHG. There was some evidence that the addition of hydrogen peroxide could have a positive effect in the reduction of <i>C. acnes</i> skin load; however, more studies are required.