دورية أكاديمية
Topical Preparations for Reducing Cutibacterium acnes Infections in Shoulder Surgery: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.
| العنوان: | Topical Preparations for Reducing Cutibacterium acnes Infections in Shoulder Surgery: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. |
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| المؤلفون: | Sewpaul Y; Lancaster University Medical School, Lancaster, UK., Huynh R; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK., Leung B; Royal London Hospital, Barts Health NHS Trust, London, UK., Alcock H; Nottingham University Hospitals NHS Trust, Nottingham, UK., Nayar SK; Whittington Health NHS Trust, London, UK., Rashid MS; Manchester University NHS Foundation Trust, Manchester, UK. |
| المصدر: | The American journal of sports medicine [Am J Sports Med] 2024 Apr 09, pp. 3635465231223877. Date of Electronic Publication: 2024 Apr 09. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Sage Publications Country of Publication: United States NLM ID: 7609541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-3365 (Electronic) Linking ISSN: 03635465 NLM ISO Abbreviation: Am J Sports Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2004- : Thousand Oaks, CA : Sage Publications Original Publication: Baltimore, Williams & Wilkins. |
| مستخلص: | Background: Cutibacterium acnes ( C acnes ) is a commensal skin bacterium, primarily found in sebaceous glands and hair follicles, with a high prevalence in the shoulder region. It is the most common pathogenic organism in prosthetic joint infections after shoulder arthroplasty. Because of its low virulence, its diagnosis remains difficult. Purpose: To evaluate the relative effects of topical preparations in reducing C acnes in shoulder surgery. Study Design: Meta-analysis; Level of evidence, 1. Methods: We searched the MEDLINE, Embase, PsychINFO, and Cochrane Library databases in March 2022. Randomized controlled trials (RCTs) comparing any form of topical preparation in arthroscopic or open shoulder surgery were included. The primary outcome was a reduction in the number of positive C acnes cultures. Secondary outcomes were adverse events related to the application of topical preparations. We performed a network meta-analysis to facilitate simultaneous comparisons between multiple preparations across studies. We calculated differences between preparations using odds ratios and their 95% CIs. The risk of bias was assessed using the Cochrane risk-of-bias tool. Results: The search yielded 17 RCTs (1350 patients), of which 9 were suitable for the network meta-analysis (775 patients). Overall, 2 RCTs were deemed as having a low risk of bias, and 15 raised "some concerns" of bias. Preparations included benzoyl peroxide (BPO), BPO combined with clindamycin, chlorhexidine gluconate, hydrogen peroxide, povidone-iodine, and water with soap. Only BPO resulted in significantly lower odds of a positive C acnes culture compared with placebo or soap and water (odds ratio, 0.12 [95% CI, 0.04-0.36]). There was no statistically significant difference with all other topical preparations. The only adverse events were skin irritation from BPO and chlorhexidine gluconate in a small number of reported cases. Conclusion: BPO was the most effective topical agent in reducing the prevalence of C acnes in shoulder surgery. These results were limited by a combination of indirect and direct data. Future studies should focus on establishing the optimal frequency and duration of preoperative BPO to further reduce the burden of C acnes . Registration: CRD42022310312 (PROSPERO). Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. |
| فهرسة مساهمة: | Keywords: C acnes; Cutibacterium acnes; P acnes; Propionibacterium acnes; benzoyl peroxide; chlorhexidine gluconate; shoulder arthroplasty; shoulder arthroscopic surgery; shoulder surgery |
| تواريخ الأحداث: | Date Created: 20240409 Latest Revision: 20240409 |
| رمز التحديث: | 20240409 |
| DOI: | 10.1177/03635465231223877 |
| PMID: | 38590237 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1552-3365 |
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| DOI: | 10.1177/03635465231223877 |