Trial reportAntimicrobial resistance and infection control2021
Comparison of the antimicrobial efficacy of povidone-iodine-alcohol versus chlorhexidine-alcohol for surgical skin preparation on the aerobic and anaerobic skin flora of the shoulder region.
Trial report in Antimicrobial resistance and infection control, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery.Scientific reports · 2021Pooled it
- Preoperative topical 5% benzoyl peroxide reduces intraoperative deep cutibacterium acnes contamination in shoulder arthroscopy: a retrospective cohort study.BMC surgery · 2026Article
- Shoulder surgery preparation: a systematic review and meta-analysis.JSES reviews, reports, and techniques · 2026Review
- Evaluating the impact of povidone-iodine irrigation on microbial contamination in reverse total shoulder arthroplasty.Bone & joint research · 2026Article
- Benzoyl peroxide combined with subcutaneous iodine reduces Cutibacterium acnes presence during shoulder surgery : a three-armed, single-blinded, randomized controlled trial.Bone & joint open · 2026Article
- Effectiveness of surgical skin preparation solutions in orthopaedic surgery: A systematic review of the current comparative literature.World journal of orthopedics · 2025Article
- Review
- Chlorhexidine vs. Povidone for Skin Antisepsis in Tissue Expander-Based Breast Reconstruction: A Propensity Score-Matched Analysis.Journal of clinical medicine · 2025Article
- 5% benzoyl peroxide is the most efficient in reducing the cutibacterium flora of the shoulder skin: a network meta-analysis.EFORT open reviews · 2025Article
- In vitro efficacy of aqueous PVP-iodine solution below 5% as alternative to preoperative antisepsis in ophthalmology as the basis for an in vivo study.Journal of ophthalmic inflammation and infection · 2025Article
- Review
- In Vitro and In Vivo Translational Insights into the Intraoperative Use of Antiseptics and Lavage Solutions Against Microorganisms Causing Orthopedic Infections.International journal of molecular sciences · 2024Article
- The shoulder microbiome: a systematic review and meta analysis.JSES reviews, reports, and techniques · 2024Review
- New Insights into Cutaneous Asepsis: Synergism between Pfaffia and Rosemary Extracts.Antibiotics (Basel, Switzerland) · 2024Article
- Risk of bacterial colonization by torniquet during arthroscopy of the knee joint.GMS hygiene and infection control · 2024Article
- S2k-Guideline hand antisepsis and hand hygiene.GMS hygiene and infection control · 2024Article
- Evaluation of the role of povidone‑iodine in the prevention of surgical site infections.Surgery open science · 2023Review
- A microbiology study on the wounds of pediatric patients undergoing spinal fusion for scoliosis.Spine deformity · 2023Observational
- Advanced Skin Antisepsis: Application of UVA-Cleavable Hydroxyethyl Starch Nanocapsules for Improved Eradication of Hair Follicle-Associated Microorganisms.Pharmaceutics · 2023Article
- Comparison of two different antiseptics regarding intracutaneous microbial load after preoperative skin cleansing in total knee and hip arthroplasties.Scientific reports · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCutibacterium acnes is part of the anaerobic skin microbiome and resides in deeper skin layers. The organism is an agent of surgical site infections (SSI) in shoulder surgery. We hypothesized that prolonged skin preparation with an agent that penetrates deeply into the skin would be beneficial. Thus, we compared two classes of antiseptics, each combined with alcohol, each applied with two different contact times.
methodsUsing a cross-over arrangement, shoulders of 16 healthy volunteers were treated for 2.5 min (standard) or 30 min (prolonged) with alcohol-based chlorhexidine (CHG-ALC) or alcohol-based povidone-iodine (PVP-I-ALC). Skin sites were sampled before, immediately after, and 3 h after treatment, using a standardized cup-scrub technique.
resultsAerobic skin flora was reduced more effectively by PVP-I-ALC than by CHG-ALC after 2.5 min application and immediate sampling (reduction factor [RF] 2.55 ± 0.75 vs. 1.94 ± 0.91, p = 0.04), but not after prolonged contact times and 3-h sampling. Coagulase-negative staphylococci were completely eliminated after PVP-I-ALC application, but still recovered from 4 of 32 samples after CHG-ALC application. Anaerobic flora was reduced more effectively by PVP-I-ALC than CHG-ALC after standard (RF 3.96 ± 1.46 vs. 1.74 ± 1.24, p < 0.01) and prolonged (RF 3.14 ± 1.20 vs. 1.38 ± 1.16, p < 0.01) contact times and immediate sampling, but not after 3-h sampling. No adverse events were reported.
conclusionsPVP-I-ALC showed marginal benefits concerning the aerobic flora, but more substantial benefits over CHG-ALC concerning the anaerobic flora of the shoulder. Standard and prolonged contact times showed superiority for PVP-I-ALC for anaerobic flora at all immediate sampling points, but missed significance at 3-h sampling. The results underscore the need for protection against C. acnes and coagulase-negative staphylococci in orthopaedic surgery. The clinical relevance of these findings, however, should be studied with SSI as an endpoint.
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Registered trials
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