Abstract
BackgroundThe skin commensal Cutibacterium avidum has been recognized as an emerging pathogen for periprosthetic joint infections (PJI). One currently assumes that the early occurring PJIs are a consequence of skin commensals contaminating the peri-implant tissue during surgery. We addressed whether standard skin antisepsis with povidone-iodine/alcohol before total hip arthroplasty (THA) is effective to eliminate colonizing bacteria with focus on C. avidum.MethodsIn a single-center, prospective study, we screened all patients for skin colonizing C. avidum in the groin before THA. Only in the patients positive for C. avidum, we preoperatively repeated skin swabs after the first and third skin antisepsis and antibiotic prophylaxis. We also obtained dermis biopsies for microbiology and fluorescence in situ hybridization (FISH).ResultsFifty-one out of 60 patients (85%) were colonized on the skin with various bacteria, in particular with C. avidum in 12 out of 60. Skin antisepsis eliminated C. avidum in eight of ten (20%) colonized patients undergoing THA. Deeper skin (dermis) biopsies were all culture negative, but FISH detected single positive ribosome-rich C. avidum in one case near sweat glands.ConclusionStandard skin antisepsis was not effective to completely eliminate colonizing C. avidum on the skin in the groin of patients undergoing THA. Colonizing with C. avidum might pose an increased risk for PJI when considering a THA. Novel more effective antisepsis strategies are needed.Trial registration No clinical trial
Highlights
The skin commensal Cutibacterium avidum has been recognized as an emerging pathogen for periprosthetic joint infections (PJI)
Various skin antisepsis agents are in use, among others povidone-iodine (PVI), chlorhexidine gluconate (CHG), or alcohol [7], which target the natural inhabitants of the human skin [11, 12]
We found that 32.3% of all patients undergoing hip arthroplasty surgery were colonized with C. avidum in the groin region, which is rich of sweat glands [16]
Summary
The skin commensal Cutibacterium avidum has been recognized as an emerging pathogen for periprosthetic joint infections (PJI). One currently assumes that the early occurring PJIs are a consequence of skin commensals contaminating the peri-implant tissue during surgery. Maurer et al Antimicrob Resist Infect Control (2021) 10:27 avidum [formerly Propionibacterium acnes and avidum, respectively]) [2]. These bacteria cause infections, which are difficult to treat because they hide in a self-made biofilm consisting of an extracellular matrix of polymeric substances [3]. Prevention strategies are multifaceted with the focus on perioperative antibiotic prophylaxis within 30–60 minutes before surgery and on skin antisepsis immediately before surgical incision of the skin [7, 9, 10]. Various skin antisepsis agents are in use, among others povidone-iodine (PVI), chlorhexidine gluconate (CHG), or alcohol [7], which target the natural inhabitants of the human skin [11, 12]
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