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.