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).

中文翻译：

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减少肩部手术中痤疮皮肤杆菌感染的局部制剂：随机对照试验的系统回顾和网络荟萃分析

背景：痤疮皮肤杆菌（C acnes）是一种皮肤共生细菌，主要存在于皮脂腺和毛囊中，在肩部区域发病率较高。它是肩关节置换术后假体关节感染中最常见的致病菌。由于其毒力低，其诊断仍然很困难。目的：评估肩部手术中局部制剂减少痤疮丙酸杆菌的相对效果。研究设计：荟萃分析；证据水平，1.方法：我们于 2022 年 3 月检索了 MEDLINE、Embase、PsychINFO 和 Cochrane 图书馆数据库。其中包括比较关节镜或开放肩部手术中任何形式的局部制剂的随机对照试验 (RCT)。主要结果是痤疮丙酸杆菌培养物阳性数量减少。次要结局是与局部制剂的应用相关的不良事件。我们进行了网络荟萃分析，以促进跨研究的多种制剂之间的同时比较。我们使用比值比及其 95% CI 计算了制剂之间的差异。使用Cochrane偏倚风险工具评估偏倚风险。结果：搜索产生了17个RCT（1350名患者），其中9个适合网络荟萃分析（775名患者）。总体而言，2 项随机对照试验被认为具有较低的偏倚风险，15 项随机对照试验提出了偏倚的“一些担忧”。制剂包括过氧化苯甲酰（BPO）、BPO与克林霉素、葡萄糖酸氯己定、过氧化氢、聚维酮碘和肥皂水组合。与安慰剂或肥皂和水相比，仅 BPO 导致痤疮丙酸杆菌培养物阳性的几率显着降低（比值比，0.12 [95% CI，0.04-0.36]）。与所有其他外用制剂没有统计学上的显着差异。在少数报告的病例中，唯一的不良事件是 BPO 和葡萄糖酸氯己定引起的皮肤刺激。 结论：BPO 是减少肩部手术中痤疮丙酸杆菌发生率最有效的外用药物。这些结果受到间接和直接数据组合的限制。未来的研究应侧重于确定术前 BPO 的最佳频率和持续时间，以进一步减轻痤疮丙酸杆菌的负担。注册：CRD42022310312 (PROSPERO)。