Benzoyl Peroxide May Reduce Risk of P.acnes Infection After Surgery

Paul M. Sethi, MD Orthopaedic & Neurosurgery Specialists Greenwich, CT Interview with:
Paul M. Sethi, MD
Orthopaedic & Neurosurgery Specialists
Greenwich, CT

MedicalResearch: What is the background for this study?

Dr. Sethi: Propionibacterium acnes is one of the most significant pathogens in shoulder surgery; the cost of a single infection after shoulder arthroplasty may be upwards $50,000. Residual P. acnes may be found on the skin 29% of the time immediately after surgical skin preparation and in 70% of dermal biopsy specimens. Identifying more ideal skin preparation may help reduce the risk of infection.

MedicalResearch: What is the purpose of this study?

Dr. Sethi: The purpose of this study was to evaluate the ability of topical benzoyl peroxide (BPO) cream, along with chlorhexidine skin preparation, to reduce the chance of identifying residual bacteria after skin preparation. Our hypothesis was that adding topical benzoyl peroxide to our skin preparation would reduce the number of positive P. acnes cultures identified during surgery.

MedicalResearch: What are the main findings?

Dr. Sethi: This study demonstrates that adding topical benzoyl peroxide (BPO) cream to current skin preparation reduces the rate at which residual P. acnes is identified. When topical BPO cream is used 48 hours before shoulder surgery, there was no significant detectable difference in the rate of positive cultures between a control air swab and surgically obtained samples. Our findings are important as recent studies have demonstrated a 36% to 70% increased risk above controls for having a positive P. acnes culture.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Sethi: Benzoyl Peroxide (BPO) along with current surgical preparation reduced the risk of P. acnes. Application of BPO is an effective way to reduce P. acnes on skin at the beginning and, importantly at the end of surgical procedure. This may result in a lower risk for postoperative infection. This is a safe and effective adjunct to help decrease the risk for post-operative infection after shoulder surgery.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Sethi: We plan on a multi-center longitudinal study to determine if this new skin preparation will reduce the actual rate of infection in shoulder arthroplasty across a broad group of patients. This is very exciting as this is a simple, safe and in expensive way to reduce post-operative infection, a potentially devastating problem.


Efficacy of topical benzoyl peroxide on the reduction of Propionibacterium acnes during shoulder surgery

James R. Sabetta, MD Vishal P. Rana, BS Katherine B. Vadasdi, MD R. Timothy Greene, MD James G. Cunningham, MD Seth R. Miller, MD, Paul M. Sethi, MD

Journal of Shoulder and Elbow Surgery

Volume 24, Issue 7, July 2015, Pages 995–1004

Paul M. Sethi, MD, & Orthopaedic & Neurosurgery Specialists (2015). Benzoyl Peroxide May Reduce Risk of P.acnes Infection After Surgery 

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