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Preoperative skin preparations for total shoulder arthroplasty (TSA) are not standardized for Cutibacterium acnes eradication. Topical benzyl peroxide (BPO) and benzyl peroxide with clindamycin (BPO-C) have been shown to reduce the bacterial load of C acnes on the skin. Our aim was to investigate whether preoperative application of these topical antimicrobials reduced superficial colonization and deep tissue inoculation of C acnes in patients undergoing TSA. In a prospective, single-blinded randomized controlled trial, 101 patients undergoing primary TSA were randomized to receive either topical pHisoHex (hexachlorophene [1% triclosan; sodium benzoate, 5 mg/mL; and benzyl alcohol, 5 mg/mL]) (n = 35), 5% BPO (n = 33), or 5% BPO with 1% clindamycin (n = 33). Skin swabs obtained prior to topical application and after topical application before surgery, as well as 3 intraoperative swabs (dermis after incision, on joint capsule entry, and dermis at wound closure), were cultured. The primary outcome was positive culture findings and successful decolonization. All 3 topical preparations were effective in decreasing the rate of C acnes. The application of pHisoHex reduced skin colonization by 50%, BPO reduced skin colonization by 73.7%, and BPO-C reduced skin colonization by 81.5%. The topical preparation of BPO-C was more effective in decreasing the rate of C acnes at the preoperative and intraoperative swab time points compared with pHisoHex and BPO (P =.003). Failure to eradicate C acnes with topical preparations consistently resulted in deep tissue inoculation. There was an increase in the C acnes contamination rate on the skin during closure (33%) compared with skin cultures taken at surgery commencement (22%). Topical application of BPO and BPO-C preoperatively is more effective than pHisoHex in reducing colonization and contamination of the surgical field with C acnes in patients undergoing TSA. [ABSTRACT FROM AUTHOR]

Purpose: We review the epidemiology, clinical presentation, management and outcome of prostatic abscess secondary to Burkholderia pseudomallei infection in the Northern Territory, Australia. We highlight the frequency of prostatic abscess occurrence in melioidosis, and formulate recommendations for its detection and management. Materials and Methods: We reviewed a prospective database of all culture confirmed melioidosis cases in the Northern Territory between October 1989 and July 2008. This review was supplemented with data obtained from a review of case notes and postmortem records during the same period. Results: There were 514 patients with 561 episodes of melioidosis, and of these patients 394 (70%) were male. A prostatic abscess was identified, usually by computerized tomography, in 81 (21%) of these episodes, in 77 patients. In 75 (93%) of the 81 episodes there was clinical evidence of prostatic infection or positive urine culture for B. pseudomallei. Kava use and hazardous alcohol use were independent predictors of prostatic abscesses compared to male patients without prostatic abscesses. All were treated with antibiotics and in 57 of the 81 episodes the abscesses were drained. Ultrasound guided needle drainage was used in 51 instances and open drainage in 28 (transurethral 13, transrectal 11, transperineal 4). There were 20 patients who underwent multiple procedures while 24 underwent no procedures. Conclusions: Prostatic abscess is common in melioidosis. Clinical signs are usually present but may be subtle. Detection is enhanced by routine computerized tomographic screening of the abdomen and pelvis for occult visceral abscesses in all cases of melioidosis. Ultrasound guided needle drainage is adequate initial therapy in conjunction with appropriate antibiotics. [Copyright &y& Elsevier]