Topical Treatments in Reducing Propionibacterium Acnes Infection in Shoulder Surgery: Protocol for a Systematic Review and Meta-analysis

INTRODUCTION: Propionibacterium acnes is a gram-positive anaerobe that is found on the dermis and epidermis of the shoulder and is the most commonly identifiable cause of periprosthetic shoulder joint infection. Various topical strategies have been investigated to reduce the prevalence of P acnes, with several demonstrating efficacy in reducing the positive culture. The aim of this systematic review and meta-analysis is to review the literature to assess the effectiveness of topical preparations in reducing the prevalence of P acnes in shoulder surgery. METHODS: The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Databases used for the literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library. Randomised controlled trials (RCTs) evaluating the use of any topical preparation against placebo, in all types of shoulder surgery, will be included. Our primary outcome is the number of colony forming units of P acnes. Secondary outcomes will include adverse events such as skin irritation, wound dehiscence, and the incidence of revision surgery due to infection. The Cochrane Risk of Bias Tool 2.0 and Jadad score will be used to assess the quality of methodology of the studies. Statistical analysis will be used to assess inconsistency and bias across included studies. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate. ETHICS AND DISSEMINATION: No ethical clearances required for this study. This systematic review and meta-analysis will be published in a peer-reviewed journal. HIGHLIGHTS: Various topical strategies have been investigated to reduce the prevalence of P acnes, the most common identifiable cause of periprosthetic shoulder joint infection, with several demonstrating efficacy in reducing the positive culture. This systematic review and meta-analysis evaluates the effectiveness of topical preparations in reducing the prevalence of P acnes in shoulder surgery. Our primary outcome is the number of colony forming units of P acnes. REGISTRATION: PROSPERO 2022 CRD42022310312.