{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:39:45Z","timestamp":1787755185241,"version":"build-2784847793"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Reducing the rising health-care burden associated with shoulder surgical site infection (SSI) is of paramount importance. The purpose of this study was to investigate the antimicrobial efficacy of protocatechuic acid (PCA) as a topical reagent for surgical skin antisepsis surrounding the shoulder joint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This was a 2-phase skin-disinfection trial involving the human shoulder. The shoulders of healthy volunteers were randomized to topical treatment with PCA (a 10% concentration of PCA in Phase I [11 subjects] and a 17% concentration in Phase II [12 subjects]), with a control of isopropyl alcohol (IPA) applied to the contralateral shoulder. Mechanical scraping was performed for skin harvest following reagent application, and samples were sent for aerobic and anaerobic culture. Sterilization rates and bacterial counts were determined for each treatment group, and the proportion of subjects with persistent\n                      <jats:italic toggle=\"yes\">Cutibacterium acnes<\/jats:italic>\n                      colonization following topical application of PCA was determined using DNA sequencing analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The topical application of 10% PCA was associated with significantly higher aerobic and anaerobic sterilization rates (90.9% and 81.8%, respectively) compared with treatment with IPA (p = 0.0143 and p = 0.0253, respectively). The topical application of 17% PCA was associated with a significantly higher anaerobic sterilization rate (83.3%) and trended toward a significantly higher aerobic sterilization rate (91.7%) compared with treatment with IPA (p = 0.0143 and p = 0.083, respectively).\n                      <jats:italic toggle=\"yes\">C. acnes<\/jats:italic>\n                      was identified in 18.2% and 0% of subjects following treatment with 10% and 17% PCA, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      The topical application of PCA was associated with a reduction in the bacterial burden of human shoulder skin and demonstrated dose-dependent antimicrobial activity against\n                      <jats:italic toggle=\"yes\">C. acnes<\/jats:italic>\n                      in young, healthy subjects. Clinical studies in a shoulder surgical population are warranted to determine the potential for application in surgical skin antisepsis to reduce shoulder SSI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.19.00078","type":"journal-article","created":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T11:00:41Z","timestamp":1594983641000},"page":"e19.00078-e19.00078","source":"Crossref","is-referenced-by-count":6,"title":["Reduced Bacterial Burden of the Skin Surrounding the Shoulder Joint Following Topical Protocatechuic Acid Application"],"prefix":"10.2106","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2511-4621","authenticated-orcid":false,"given":"Omid","family":"Jalali","sequence":"first","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5571-4153","authenticated-orcid":false,"given":"Molly","family":"Best","sequence":"additional","affiliation":[{"name":"Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0398-6480","authenticated-orcid":false,"given":"Alison","family":"Wong","sequence":"additional","affiliation":[{"name":"Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0784-9141","authenticated-orcid":false,"given":"Brett","family":"Schaeffer","sequence":"additional","affiliation":[{"name":"Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0666-1411","authenticated-orcid":false,"given":"Brendon","family":"Bauer","sequence":"additional","affiliation":[{"name":"Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1433-4410","authenticated-orcid":false,"given":"Lanny","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020]]},"reference":[{"issue":"4","key":"R1-20230807","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1086\/502033","article-title":"The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost","volume":"23","author":"Whitehouse","year":"2002","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"6","key":"R2-20230807","doi-asserted-by":"crossref","first-page":"442","DOI":"10.2106\/JBJS.M.00258","article-title":"Sensitivity of frozen section histology for identifying Propionibacterium acnes infections in revision shoulder arthroplasty","volume":"96","author":"Grosso","year":"2014","journal-title":"J Bone Joint Surg Am"},{"key":"R3-20230807","doi-asserted-by":"crossref","first-page":"804391","DOI":"10.1155\/2013\/804391","article-title":"Propionibacterium acnes: an underestimated pathogen in implant-associated infections","volume":"2013","author":"Portillo","year":"2013","journal-title":"Biomed Res Int"},{"issue":"10","key":"R4-20230807","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1016\/j.jse.2018.04.019","article-title":"Cutibacterium acnes and the shoulder microbiome","volume":"27","author":"Qiu","year":"2018","journal-title":"J Shoulder Elbow Surg"},{"issue":"23","key":"R5-20230807","doi-asserted-by":"crossref","first-page":"e1811","DOI":"10.2106\/JBJS.L.01733","article-title":"Origin of Propionibacterium in surgical wounds and evidence-based approach for culturing Propionibacterium from surgical sites","volume":"95","author":"Matsen","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"R6-20230807","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.jse.2015.08.002","article-title":"Frequent isolation of Propionibacterium acnes from the shoulder dermis despite skin preparation and prophylactic antibiotics","volume":"25","author":"Phadnis","year":"2016","journal-title":"J Shoulder Elbow Surg"},{"issue":"11","key":"R7-20230807","doi-asserted-by":"crossref","first-page":"958","DOI":"10.2106\/JBJS.17.00584","article-title":"Preoperative doxycycline does not reduce Propionibacterium acnes in shoulder arthroplasty","volume":"100","author":"Rao","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"R8-20230807","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1128\/AAC.47.6.1988-1990.2003","article-title":"Eradication of resident bacteria of normal human skin by antimicrobial ointment","volume":"47","author":"Hendley","year":"2003","journal-title":"Antimicrob Agents Chemother"},{"issue":"17","key":"R9-20230807","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.2106\/JBJS.M.01474","article-title":"Propionibacterium persists in the skin despite standard surgical preparation","volume":"96","author":"Lee","year":"2014","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"R10-20230807","doi-asserted-by":"crossref","first-page":"e0078","DOI":"10.1016\/j.arthro.2018.01.019","article-title":"Propionibacterium acnes persists despite various skin preparation techniques","volume":"34","author":"Heckmann","year":"2018","journal-title":"Arthroscopy"},{"issue":"3","key":"R11-20230807","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1186\/cc13948","article-title":"The future of antibiotics","volume":"18","author":"Spellberg","year":"2014","journal-title":"Crit Care"},{"issue":"10","key":"R13-20230807","doi-asserted-by":"crossref","first-page":"18219","DOI":"10.3390\/molecules201018219","article-title":"Potential of essential oils as penetration enhancers for transdermal administration of ibuprofen to treat dysmenorrhoea","volume":"20","author":"Chen","year":"2015","journal-title":"Molecules"},{"issue":"1","key":"R14-20230807","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1080\/13880209.2017.1312464","article-title":"Development of essential oils as skin permeation enhancers: penetration enhancement effect and mechanism of action","volume":"55","author":"Jiang","year":"2017","journal-title":"Pharm Biol"},{"issue":"11","key":"R15-20230807","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1016\/j.bbamem.2009.08.015","article-title":"Enhancement of transdermal drug delivery via synergistic action of chemicals","volume":"1788","author":"Karande","year":"2009","journal-title":"Biochim Biophys Acta"},{"issue":"5","key":"R16-20230807","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.jse.2014.11.044","article-title":"Periprosthetic shoulder infection in the United States: incidence and economic burden","volume":"24","author":"Padegimas","year":"2015","journal-title":"J Shoulder Elbow Surg"},{"issue":"9","key":"R17-20230807","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/j.jse.2018.06.012","article-title":"Neer Award 2018: benzoyl peroxide effectively decreases preoperative Cutibacterium acnes shoulder burden: a prospective randomized controlled trial","volume":"27","author":"Kolakowski","year":"2018","journal-title":"J Shoulder Elbow Surg"},{"issue":"7","key":"R18-20230807","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1128\/JCM.00450-11","article-title":"Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection","volume":"49","author":"Butler-Wu","year":"2011","journal-title":"J Clin Microbiol"},{"issue":"12","key":"R19-20230807","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1016\/j.jse.2019.06.016","article-title":"Cutibacterium acnes persists despite topical clindamycin and benzoyl peroxide","volume":"28","author":"Heckmann","year":"2019","journal-title":"J Shoulder Elbow Surg"},{"key":"R20-20230807","doi-asserted-by":"crossref","first-page":"952943","DOI":"10.1155\/2014\/952943","article-title":"A review on protocatechuic acid and its pharmacological potential","volume":"2014","author":"Kakkar","year":"2014","journal-title":"ISRN Pharmacol"},{"issue":"4","key":"R21-20230807","first-page":"643","article-title":"Pharmacological activities of protocatechuic acid","volume":"72","author":"Khan","year":"2015","journal-title":"Acta Pol Pharm"},{"key":"R22-20230807","doi-asserted-by":"crossref","first-page":"593902","DOI":"10.1155\/2015\/593902","article-title":"Pharmacological properties of protocatechuic acid and its potential roles as complementary medicine","volume":"2015","author":"Semaming","year":"2015","journal-title":"Evid Based Complement Alternat Med"},{"issue":"1","key":"R23-20230807","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1186\/s12906-018-2320-8","article-title":"Inhibitory effects of Euphorbia supina on Propionibacterium acnes-induced skin inflammation in vitro and in vivo","volume":"18","author":"Lim","year":"2018","journal-title":"BMC Complement Altern Med"},{"issue":"3","key":"R24-20230807","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.jep.2009.05.003","article-title":"Antimicrobial activity of the crude extract, fractions and compounds from stem bark of Ficus ovata (Moraceae)","volume":"124","author":"Kuete","year":"2009","journal-title":"J Ethnopharmacol"},{"issue":"5","key":"R25-20230807","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1111\/ics.12072","article-title":"Release and in vitro skin permeation of polyphenols from cosmetic emulsions","volume":"35","author":"Zillich","year":"2013","journal-title":"Int J Cosmet Sci"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.19.00078","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:38:50Z","timestamp":1787751530000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.19.00078"}},"subtitle":["Results of a Pilot Study"],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.19.00078","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]}}}