背景:肩关节假体周围感染(PJI)最常见的是由镰刀菌引起。有效地从皮肤上去除这些细菌是困难的,因为在皮肤表面下的皮肤皮脂腺中保护的切细菌,如葡萄糖酸氯己定(CHG),是应用的。关于使用过氧化氢(H2O2)作为CHG的辅助手段在消除皮肤上的Cutibacterium方面的额外益处存在矛盾的证据。先前的一项研究表明,在CHG皮肤准备后,在施用后60分钟,在90%的肩部中发生从皮脂腺到皮肤表面上的残余杆菌的再繁殖。这项随机对照研究的目的是确定向CHG中添加H2O2减少皮肤残余杆菌的有效性。
方法:本研究招募了18名男性志愿者(36肩)。每位志愿者的两个肩膀随机接受对照制剂(“仅CHG”-仅在70%异丙醇[ISA]中的2%CHG)或研究制剂(“H2O2CHG”-3%H2O2,然后在70%ISA中的2%CHG)。在皮肤制备之前并在制备后60分钟再次从每个肩部取皮肤拭子。培养拭子中的Cutubacterium并观察14天。使用基于在培养板上生长的象限的数量的半定量系统来报告切杆菌皮肤负荷。
结果:在皮肤准备之前,100%的仅CHG肩和100%的H2O2CHG肩具有阳性的皮肤表面培养物。在仅有CHG的78%和H2O2+CHG的78%的肩部(p=1.00)中,在60分钟时在皮肤上重新繁殖回杆菌。在只有56%的CHG和61%的H2O2CHG肩部(p=0.735)的情况下,皮肤上的Cutubacterium水平降低。在仅CHG组(2.1±0.8至1.3±0.9,p=0.003)和H2O2+CHG组(2.2±0.7至1.4±0.9,p<0.001)中,从皮肤制备前到制备后60分钟,切杆菌水平显著降低。在两种制备后的60分钟时,皮肤表面存在大量水平的Cutubacterium。
结论:在这项随机对照研究中,使用过氧化氢作为葡萄糖酸氯己定皮肤制剂的辅助药物,对降低皮肤中的切杆菌水平没有额外的益处.两种制剂都无法从真皮皮脂腺中消除皮肤表面上的镰刀菌的繁殖。
BACKGROUND: Shoulder periprosthetic joint infection is most commonly caused by Cutibacterium. Effective removal of these bacteria from the skin is difficult because Cutibacterium live protected in the dermal sebaceous glands beneath the skin surface to which surgical preparation solutions, such as chlorhexidine gluconate (CHG), are applied. There is conflicting evidence on the additional benefit of using hydrogen peroxide (H2O2) as an adjunct to CHG in eliminating Cutibacterium from the skin. A previous
study demonstrated that after CHG skin preparation, repopulation of Cutibacterium from sebaceous glands onto the skin surface occurs in 90% of shoulders by 60 minutes after application. The objective of this randomized controlled
study was to determine the effectiveness of adding H2O2 to CHG in reducing skin Cutibacterium.
METHODS: Eighteen male volunteers (36 shoulders) were recruited for this
study. The 2 shoulders of each volunteer were randomized to receive the control preparation (\"CHG-only\" - 2% CHG in 70% isopropyl alcohol alone) or the
study preparation (\"H2O2+CHG\" - 3% H2O2 followed by 2% CHG in 70% isopropyl alcohol). Skin swabs were taken from each shoulder prior to skin preparation and again at 60 minutes after preparation. Swabs were cultured for Cutibacterium and observed for 14 days. Cutibacterium skin load was reported using a semiquantitative system based on the number of quadrants growing on the culture plate.
RESULTS: Prior to skin preparation, 100% of the CHG-only shoulders and 100% of the H2O2+CHG shoulders had positive skin surface cultures for Cutibacterium. Repopulation of Cutibacterium on the skin at 60 minutes occurred in 78% of CHG-only and 78% of H2O2+CHG shoulders (P = 1.00). Reduction of Cutibacterium skin levels occurred in 56% of CHG-only and 61% of H2O2+CHG shoulders (P = .735). Cutibacterium levels were significantly decreased from before skin preparation to 60 minutes after preparation in both the CHG-only (2.1 ± 0.8 to 1.3 ± 0.9, P = .003) and the H2O2+CHG groups (2.2 ± 0.7 to 1.4 ± 0.9, P < .001). Substantial skin surface levels of Cutibacterium were present at 60 minutes after both preparations.
CONCLUSIONS: In this randomized controlled
study, there was no additional benefit of using hydrogen peroxide as an adjunct to chlorhexidine gluconate skin preparation in the reduction of cutaneous Cutibacterium levels. Neither preparation was able to eliminate repopulation of Cutibacterium on the skin surface from the dermal sebaceous glands.