2133. Cutibacterium acne Surgical Site Infections: Case Series From a University-Affiliated Hospital Network

BACKGROUND: Cutibacterium (formerly Propionibacterium) acne, residing on skin, hair follicles, and sebaceous glands, can persist in the dermal layer despite standard surgical skin preparations. Traditionally considered a colonizer, it’s been increasingly recognized as a cause of surgical site infections (SSI). We aimed to gain further clinical insight into C. acne’s role in SSI. METHODS: Study design: retrospective chart review. Study Time: January 1, 2013–December 31, 2017. Study Setting: three hospitals within University of Wisconsin Health network. Case identification: all patients with ≥1 postoperative culture positive for C. acne. We defined SSI by CDC criteria, and collected basic demographic and relevant clinical variables. RESULTS: We identified 77 patients with C. acne postoperative cultures: neurosurgical (61%), orthopedic (17%), cardiothoracic (9%), general surgery (8%), and other surgical departments (5%). Forty-six (60%) of the patients were male. Time from surgery to positive culture was median 24 days (range: 1–670), with > 30 days in 36% patients. Infection and colonization were present in 77 and 23% of the patients, respectively. Infected patients were more likely to have wound infection on examination (OR 5.8 [1.4–27.9, P = 0.004), but had no significant difference in temperature, leukocytosis, or C-reactive protein compared with colonized patients. Additional surgeries for debridement, implant revision, or device re-implantation were needed in 62% of the patients. Length of hospital stay due to SSI was prolonged by median 6 days (range 0–33). Median antibiotic duration was 2 weeks, with 25% patients receiving antibiotics for ≥6 weeks. Infection outcomes included cure (86%), chronic infection (3%), transition to hospice (3%), and recurrence (8%). All six patients with recurrences had neurosurgeries and did not receive antibiotics after the initial positive culture (infection not recognized). CONCLUSION: SSI caused by C. acne are associated with significant morbidity, especially in patients undergoing implant-related neurosurgical or orthopedic procedures. Due to low virulence and slow-growing properties, time to infection may be prolonged, and traditional inflammatory markers may be lacking. Early recognition of infection, while challenging, is crucial to improving postoperative patient outcomes. DISCLOSURES: All authors: No reported disclosures.