ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Preoperative benzoyl peroxide 5% reduces early Cutibacterium acnes-related postoperative spinal implant infections: a quasi-experimental study.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 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
aimsPostoperative spinal implant infections (PSIIs) are serious complications in spinal deformity surgery, with Cutibacterium acnes representing a frequent pathogen. This study aimed to evaluate whether adding of preoperative topical benzoyl peroxide (BPO) 5% to standard antibiotic prophylaxis could reduce early C. acnes-related and overall PSIIs.
methodsA retrospective quasi-experimental study was performed at a tertiary spinal surgery center, including two sequential 12-month cohorts of patients undergoing corrective spinal surgery. The control group received standard intravenous antibiotic prophylaxis, while the intervention group received additional topical BPO 5% applied twice daily for three days before surgery. The primary outcome was the incidence of early C. acnes PSIIs within 90 days; the secondary outcome was the incidence of overall early PSIIs.
resultsA total of 160 patients were analyzed (80 per group). Baseline demographic and surgical characteristics were comparable. Early PSIIs occurred in 12 patients (7.5% overall). The incidence was significantly lower in the BPO group compared with the standard care group (2.5% vs. 12.5%, p = 0.036). C. acnes-related PSIIs occurred in one patient (1.3%) in the BPO group and six patients (7.5%) in the control group, representing a numerical reduction that did not reach statistical significance (HR:0.182[95%CI:0.022;1.52]). Cox regression showed lower hazard of overall infection in the BPO group compared with the SoC group (HR:0.21[95%CI:0.046;0.960]), although based on a small number of infections.
conclusionPreoperative application of BPO 5%, in combination with standard antibiotic prophylaxis, was associated with a significant reduction in overall early PSIIs and with a clinically meaningful but statistically non-significant reduction in C. acnes-related PSIIs. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies. This simple, low-cost, and readily implementable adjunct may represent an effective addition to infection-prevention strategies in spinal surgery.
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