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Background  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. 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 .    Methods  In 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).    Results  Fifty-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.    Conclusion  Standard 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

Cutibacterium avidum resists surgical skin antisepsis in the groin—a potential risk factor for periprosthetic joint infection: a quality control study