From the Department of Orthopaedic Surgery, Community Memorial Health System, Ventura (Dr. Sanderson, Dr. Saini) (Sanderson and Saini); the College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona (Chiang); the California State University Channel Islands, Camarillo, CA (Dr. Linton); the Orthopaedic Oncology in the Samuel Oschin Comprehensive Cancer Institute (Dr. Brien); the Sarcoma and Bone Tumor Program, Los Angeles, CA (Dr. Brien); and the Department of Orthopaedics, Physician Relations and Referral Enhancement (Dr. Brien).
J Am Acad Orthop Surg Glob Res Rev. 2022 Jul 6;6(7). doi: 10.5435/JAAOSGlobal-D-22-00010. eCollection 2022 Jul 1.
The clinical significance and treatment recommendations for an unexpected positive Cutibacterium acnes (C acnes) culture remain unclear. The purpose of our study was to evaluate the clinical effect of a C acnes positive culture in patients undergoing open orthopaedic surgery.
Patients with a minimum of one positive C acnes intraoperative culture were retrospectively reviewed over a 7-year period. True C acnes infection was defined as culture isolation from ≥1 specimens in the presence of clinical or laboratory indicators of infection.
Forty-eight patients had a positive intraoperative C acnes culture. 4.2% had a C acnes monoinfection, and 12.5% of the patients had a coinfection. The remainder was classified as indeterminate. Significant differences were identified between the indeterminate and true C acnes infection groups, specifically in patients with surgery history at the surgical site (P = 0.04), additional antibiotic therapy before surgery (P < 0 .001), and postoperative clinical signs of infection (P < 0 .001).
Suspicion for true C acnes infection should be raised in patients with surgery site history, antibiotic therapy before surgery, and clinical infectious signs. The indeterminate unexpected positive culture patients had a low risk of developing a true clinical infection that required antibiotic therapy.
对于意外的痤疮丙酸杆菌（C acnes）阳性培养物的临床意义和治疗建议仍不清楚。我们的研究目的是评估开放性骨科手术患者中 C acnes 阳性培养物的临床效果。
回顾性分析了 7 年内至少有 1 次术中 C acnes 阳性培养的患者。真正的 C acnes 感染定义为在存在感染的临床或实验室指标的情况下，从≥1 个标本中分离出 C acnes。
48 例患者术中 C acnes 培养阳性。4.2%的患者为单纯 C acnes 感染，12.5%的患者为混合感染。其余的被归类为不确定。在有手术史的患者（P=0.04）、术前接受抗生素治疗（P<0.001）和术后感染临床体征（P<0.001）方面，不确定和真正的 C acnes 感染组之间存在显著差异。
对于有手术部位史、术前抗生素治疗和临床感染体征的患者，应怀疑真正的 C acnes 感染。不确定的意外阳性培养患者发生需要抗生素治疗的真正临床感染的风险较低。
