Key takeaways:
- Subcutaneous chlorhexidine irrigation throughout shoulder arthroplasty decreased optimistic deep C. acnes tradition charges.
- Regular saline irrigation had greater than double the danger of C. acnes contamination.
Sufferers who acquired subcutaneous 0.05% chlorhexidine gluconate antisepsis throughout main complete shoulder arthroplasty had a considerably decreased charge of optimistic deep cultures of Cutibacterium acnes, in accordance with a research.
“Utilizing a comparatively small quantity (100 mL) of a low-cost, low-barrier product, like 0.05% chlorhexidine, was proven to make a major affect on deep tradition charges,” Hafiz F. Kassam, MD, of Hoag Orthopedic Institute, in California, informed Healio. “The hope is that this might have a concurrent scientific impact by decreasing an infection charges in affected person outcomes.”
The research was printed within the Journal of Shoulder and Elbow Surgical procedure.
Kassam and colleagues randomly assigned 126 sufferers present process both main anatomic or reverse TSA to both subcutaneous lavage with a 0.05% chlorhexidine gluconate resolution (n = 63) or regular saline (n = 63). Researchers collected 5 tradition samples throughout surgical procedure — one pores and skin tradition, two superficial subcutaneous cultures and two deep cultures — which had been incubated and examined for C. acnes development for 21 days.
As the first final result, the researchers aimed to find out the efficacy of 0.05% chlorhexidine gluconate resolution in decreasing C. acnes bacterial tradition charges throughout surgical procedure in contrast with regular saline.
Though efficacy of 0.05% chlorhexidine gluconate resolution or regular saline irrigation didn’t differ on the superficial layer, the research did present a distinction on a deep surgical stage. Outcomes confirmed sufferers who acquired regular saline irrigation alone had greater than double the danger of C. acnes contamination on the deep surgical stage. Researchers additionally discovered the danger of C. acnes contamination on the deep surgical stage was extra pronounced when male sufferers had been remoted.
“[These results] present the utilization of intraoperative 0.05% chlorhexidine, notably of the subcutaneous layer the place we all know C. acnes exists, along with our normal preoperative chlorhexidine pores and skin preparations would possibly make a major affect in decreasing C. acnes burden in shoulder arthroplasty sufferers, which we all know is a major poor final result driver,” Kassam mentioned.
For extra data:
Hafiz F. Kassam, MD, needs to be contacted by way of Hannah Lew at hannah@millergeer.com.
Perspective
Two current research in Journal of Shoulder and Elbow Surgical procedure examine intraoperative irrigation with dilute chlorhexidine gluconate to cut back Cutibacterium acnes tradition positivity. These randomized managed trials, evaluating chlorhexidine gluconate irrigation to saline rinse, report seemingly contradictory outcomes. Hafiz F. Kassam, MD, and colleagues discovered a better than twofold discount in deep tradition positivity with chlorhexidine gluconate (10% vs. 22% for saline). In distinction, Tyler T. Bilden, MD, PharmD, and colleagues noticed an general tradition positivity charge of 8%, with no important distinction between chlorhexidine gluconate and saline teams. Notably, the research from Kassam and colleagues confirmed no distinction in tradition positivity for samples taken instantly after irrigation (tradition #3) with both resolution.
Variations in research design doubtless clarify these discrepancies. First, Kassam and colleagues irrigated solely instantly after pores and skin incision, whereas Bilden and colleagues irrigated earlier than amassing all deep cultures. Second, Bilden and colleagues used an exterior laboratory, requiring specimen delivery, which can have affected tradition viability. Third, Kassam and colleagues used swabs, whereas Bilden and colleagues used tissue cultures.
These findings recommend that irrigation with both saline or chlorhexidine gluconate simply earlier than implantation could successfully scale back intraoperative C. acnes contamination. The important issue seems to be timing the irrigation instantly previous to implant placement. If irrigation is carried out solely after the preliminary pores and skin incision, surgeons ought to strongly think about using chlorhexidine gluconate.
References:
Bilden TT, et al. J Shoulder Elbow Surg. 2025;doi:10.1016/j.jse.2024.09.023.
Kassam HF, et al. J Shoulder Elbow Surg. 2025;doi:10.1016/j.jse.2025.02.043.
Tim R. Lenters, MD
Trinity Well being – IHA Medical Group
Grand Rapids, Michigan
Disclosures: Lenters studies no related monetary disclosures.
