<i>Cutibacterium</i> colonization of the anterior and lateral thigh.

Abstract

Of growing concern in arthroplasty is the emergence of atypical infections, particularly <i>Cutibacterium</i> (formerly <i>Propionibacterium</i>) sp. infections. Currently, the dermal colonization rate of <i>Cutibacterium</i> about the hip is unknown. Therefore, the aim of this study was to investigate colonization rates of <i>Cutibacterium</i> sp. at locations approximating anterior and posterolateral approaches to the hip joint. For this non-randomized non-blinded study, 101 adult patients scheduled for hip or knee surgery were recruited. For each, four 3 mm dermal punch biopsies were collected after administration of anaesthesia, but prior to antibiotics. Prebiopsy skin preparation consisted of a standardized preoperative 2% chlorhexidine skin cleansing protocol and an additional 70% isopropyl alcohol mechanical skin scrub immediately prior to biopsy collection. Two skin samples 10 cm apart were collected from a location approximating a standard direct anterior skin incision, and two samples 10 cm apart were collected from a lateral skin incision (suitable for posterior, direct-lateral, or anterolateral approaches). Samples were cultured for two weeks using a protocol optimized for <i>Cutibacterium</i>. A total of 23 out of 404 cultures (collected from 101 patients) were positive for a microorganism, with a total of 22 patients having a positive culture (22%). Overall, 15 of the cultures in 14 patients were positive for <i>Cutibacterium</i> sp. (65%), of which <i>Cutibacterium acnes</i> comprised the majority (n = 13; 87%). Other isolated microorganisms include coagulase-negative <i>Staphylococcus</i> (n = 6), <i>Clostridium</i> (n = 1), and <i>Corynebacterium</i> (n = 1). Of all positive cultures, 15 were obtained from the anterior location (65%), of which seven (60%) were from the most proximal biopsy location. However, these findings were not statistically significant (anterior vs lateral, p = 0.076; proximal vs distal, p =0.238). Approximately 14% (14/101) of the patients demonstrated a positive <i>Cutibacterium</i> colonization about the hip, the majority anteriorly. Given the high colonization rate of <i>Cutibacterium</i>, alternative skin preparations for total hip arthroplasty should be considered. Cite this article: <i>Bone Joint J</i> 2020;102-B(7 Supple B):52-56.