ArticleBMC surgery2026
Preoperative topical 5% benzoyl peroxide reduces intraoperative deep cutibacterium acnes contamination in shoulder arthroscopy: a retrospective cohort study.
Article in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntraoperative deep contamination with Cutibacterium acnes (C. acnes) from hair follicles and sebaceous glands remains a microbiological risk in shoulder arthroscopy, and routine chlorhexidine-alcohol skin preparation has limited efficacy against this reservoir.
objectiveTo evaluate the association between preoperative topical 5% benzoyl peroxide use and intraoperative deep C. acnes contamination, and to explore skin colonization load.
methodsA retrospective cohort analysis was performed on patients undergoing shoulder arthroscopy. Deep specimens (synovial fluid, synovium, inner portal cannula wall) were obtained for anaerobic culture. The primary outcome was the patient-level deep contamination rate. Relative risks (RR), adjusted odds ratios (aOR), and incidence rate ratios (IRR) were estimated using multivariable logistic regression, Poisson regression, and non-parametric tests. Sensitivity analyses used a strict positivity definition.
resultsThe cohort included 162 patients (81 with BPO pretreatment, 81 with standard preparation alone). The BPO group had a lower deep contamination rate (16.05% vs. 34.57%; RR = 0.46, 95%CI 0.26-0.83, p = 0.007), with an adjusted aOR = 0.38 (95%CI 0.18-0.79). The number of positive deep specimens per patient was lower (IRR = 0.44, p = 0.004). Among positive cases, the time to culture positivity was delayed in the BPO group (p = 0.031). Preoperative skin colonization load was lower in the BPO group (p = 0.001). A higher skin score was independently associated with increased risk of deep contamination (aOR = 1.57 per 1-grade increase, 95%CI 1.19-2.07, p = 0.002). Sensitivity analyses showed consistent results. No significant between-group differences were found in short-term infection-related clinical events.
conclusionIn this retrospective analysis, preoperative topical 5% benzoyl peroxide was associated with a significant reduction in intraoperative deep C. acnes contamination and bacterial burden during shoulder arthroscopy, supporting the microbiological rationale for a source decolonization strategy. CLINICAL
trial registrationNot applicable.
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