title: Cyanoacrylate microbial sealant may reduce the prevalence of positive cultures in revision shoulder arthroplasty.
abstract: BACKGROUND
  Cyanoacrylate-based, microbial sealant is an adhesive skin barrier designed to prevent bacterial contamination in surgical wounds. This type of adhesive barrier could have use in decreasing the incidence of positive cultures and subsequent infection in shoulder arthroplasty.
  
  
  OBJECTIVE
  We therefore evaluated whether cyanoacrylate microbial sealant reduced the positive intraoperative culture rates in revision shoulder arthroplasty.
  
  
  METHODS
  We retrospectively reviewed 55 patients who underwent revision shoulder arthroplasties. Intraoperative aerobic and anaerobic deep tissue culture results taken during the revisions were compared. Cultures were taken of the deep synovial tissue lining the prosthesis. Patients were divided into two groups: those who underwent standard preparations with adhesive, iodine-barrier drapes (Group SP) and those who had placement of cyanoacrylate microbial sealant in addition to the standard prep (Group MS).
  
  
  RESULTS
  The prevalence of cases with positive cultures was 18% (seven of 40) in Group SP compared with 7% (one of 15) in Group MS. The prevalence of positive, anaerobic Propionibacterium acnes cultures was 13% in Group SP compared with 7% in Group MS. The prevalence of infections confirmed at revision surgery was 8% in Group SP versus 0% in Group MS.
  
  
  CONCLUSIONS
  Our observations suggest application of a cyanoacrylate microbial sealant may reduce the prevalence of positive cultures and thereby subsequent infections in revision shoulder arthroplasties.
  
  
  METHODS
  Level III, retrospective cohort study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 92354, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Lorenzetti
authors.forename: Montri D
authors.initials: MD
authors.lastname: Wongworawat
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Jobe
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Phipatanakul
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D003487:Cyanoacrylates; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D007595:Joint Prosthesis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011425:Propionibacterium acnes / Q000302:isolation & purification; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D012086:Reoperation; D012782:Shoulder / Q000382:microbiology / Q000601:surgery*; D012785:Shoulder Joint / Q000382:microbiology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates