Abstract
Introduction: Cutibacterium acnes is the most common cause of postoperative infections in orthopaedic shoulder surgery and is hard to eradicate with current measures. Newer strategies focus on reducing bacterial load on the skin before surgery. Several previous studies have used a large number of both described and undescribed sampling techniques. The purpose of this study was to compare three previously described swab techniques to obtain bacterial cultures: Levine's (L) technique, the Z technique and the pencil eraser swab (PES) technique. Methods: Three consecutive skin swabs were collected from the right shoulder, on 15 healthy male volunteers, using Levine's technique, Z technique and PES technique from each participant. To determine the number of living bacteria, serial dilutions were made, and after culturing for 5 d, viable count (VC) was expressed as CFU/mL (with CFU representing colony-forming unit). Results: The PES technique yielded significantly higher VC than the two others. PES: median 3700 CFU/mL, L: 200 CFU/mL and Z: 220 CFU/mL (). There was no significant difference between the methods regarding the number of positive cultures. PES: 14/15, L: 11/15 and Z: 12/15. Conclusions: There is a need to harmonise sampling techniques of C. acnes in order to compare the efficacy of different measures to reduce the bacterial load on the skin before and during surgery. Of the three tested methods, the PES technique is simple and produces the highest bacterial counts.
Highlights
Cutibacterium acnes is the most common cause of postoperative infections in orthopaedic shoulder surgery and is hard to eradicate with current measures
Three consecutive skin swabs were collected from the right shoulder, using the L technique, Z technique and pencil eraser swab (PES) technique from each participant
There were no significant differences between the different techniques in detecting C. acnes or CoNS (Table 1)
Summary
Cutibacterium acnes is the most common cause of postoperative infections in orthopaedic shoulder surgery and is hard to eradicate with current measures. Earlier studies have demonstrated that this species can prevail on the skin despite strict preoperative preparation with alcohol-based chlorhexidine (Lee et al, 2014; Scheer et al, 2021) This has spawned investigation of other eradication strategies, one being to evaluate whether different bactericidal creams applied before surgery can reduce the number of bacteria on the skin (Chalmers et al, 2019; Dizay et al, 2017; Hancock et al, 2018; Murray et al, 2011; Sabetta et al, 2015; Stull et al, 2020) with the presumption that this in turn will reduce bacterial load in the surgical field. Commonly, bacterial skin count is indirectly used as an assessment of the effectiveness of a method (Falk-Brynhildsen et al, 2013b; Chalmers et al, 2019; Meyer et al, 2021)
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