{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:36:51Z","timestamp":1787755011250,"version":"build-2784847793"},"reference-count":70,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>\n                    <jats:list list-type=\"plain\">\n                      <jats:list-item>\n                        <jats:p>\n                          \u00bb Benzoyl peroxide (BPO) 5% has been shown to reduce\n                          <jats:italic toggle=\"yes\">Cutibacterium acnes<\/jats:italic>\n                          load on the skin. BPO 5% with miconazole nitrate (MN) 2% may be beneficial, whereas BPO 5% with clindamycin cream 1% to 1.2% does not seem to have additive effects when compared with BPO 5% alone. Chlorhexidine gluconate solutions reduce the total bacterial load on the skin, but do not seem to have a significant effect on\n                          <jats:italic toggle=\"yes\">C. acnes<\/jats:italic>\n                          .\n                        <\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\n                          \u00bb ChloraPrep seems to be the best surgical skin preparation to decrease overall positive skin cultures. Preincisional hydrogen peroxide 3% application has been shown to be a cost-effective practice to inhibit growth of\n                          <jats:italic toggle=\"yes\">C. acnes<\/jats:italic>\n                          . Vancomycin powder before deltopectoral interval closure has antimicrobial effects against\n                          <jats:italic toggle=\"yes\">C. acnes<\/jats:italic>\n                          and is a cost-effective practice. Finally, Bactisure surgical lavage is protective against the formation of biofilms.\n                        <\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb IV cefazolin has been shown to be more effective for shoulder arthroplasty infection prophylaxis than antibiotic alternatives such as vancomycin. Thus, patients with a questionable history of penicillin allergy should undergo additional testing.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb For shoulder surgery infection prophylaxis, we recommend the use of BPO 5% cream for 5 days preoperatively with chlorhexidine wipes the night before and the morning of surgery. IV cefazolin should be administered perioperatively, and patients with a questionable history of penicillin allergy should be tested. Surgeons should consider preincisional application of hydrogen peroxide 3% for 5 minutes, followed by standard ChloraPrep preparation. Normal saline should be used for preclosure lavage. Finally, application of vancomycin powder deep to the deltopectoral interval closure should be considered.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.2106\/jbjs.rvw.22.00141","type":"journal-article","created":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T11:08:06Z","timestamp":1677150486000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Techniques for Decreasing Bacterial Load for Open Shoulder Surgery"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4976-096X","authenticated-orcid":false,"given":"Eric J.","family":"Panther","sequence":"first","affiliation":[{"name":"College of Medicine, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0682-8381","authenticated-orcid":false,"given":"Kevin A.","family":"Hao","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5788-3463","authenticated-orcid":false,"given":"Jonathan O.","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-0096","authenticated-orcid":false,"given":"Jennifer J.","family":"Schoch","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8216-3588","authenticated-orcid":false,"given":"Alaina S.","family":"Ritter","sequence":"additional","affiliation":[{"name":"Department of Infectious 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