Methods: Study design: retrospective chart review. Study Time: 1/1/2013 – 12/31/2017. 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 exam (OR 5.8 [1.4 – 27.9, P = 0.004), but had no significant difference in temperature, leukocytosis, or C-reactive protein compared to 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 6 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.
N. Safdar, None
A. Pop-Vicas, None