Related Experiment Video
Updated: Dec 17, 2025
Determination of Biofilm Initiation on Virus-infected Cells by Bacteria and Fungi
Published on: July 6, 2016
Cutibacterium colonization of the anterior and lateral thigh
Jacob M Elkins1,2, Douglas A Dennis3,4,5, Lindsay Kleeman-Forsthuber1
1Colorado Joint Replacement, Denver, Colorado, USA.
Aims:
Of growing concern in arthroplasty is the emergence of atypical infections, particularly Cutibacterium (formerly Propionibacterium) sp. infections. Currently, the dermal colonization rate of Cutibacterium about the hip is unknown. Therefore, the aim of this study was to investigate colonization rates of Cutibacterium sp. at locations approximating anterior and posterolateral approaches to the hip joint.
Methods:
For this non-randomized non-blinded study, 101 adult patients scheduled for hip or knee surgery were recruited. For each, four 3 mm dermal punch biopsies were collected after administration of anaesthesia, but prior to antibiotics. Prebiopsy skin preparation consisted of a standardized preoperative 2% chlorhexidine skin cleansing protocol and an additional 70% isopropyl alcohol mechanical skin scrub immediately prior to biopsy collection. Two skin samples 10 cm apart were collected from a location approximating a standard direct anterior skin incision, and two samples 10 cm apart were collected from a lateral skin incision (suitable for posterior, direct-lateral, or anterolateral approaches). Samples were cultured for two weeks using a protocol optimized for Cutibacterium.
Results:
A total of 23 out of 404 cultures (collected from 101 patients) were positive for a microorganism, with a total of 22 patients having a positive culture (22%). Overall, 15 of the cultures in 14 patients were positive for Cutibacterium sp. (65%), of which Cutibacterium acnes comprised the majority (n = 13; 87%). Other isolated microorganisms include coagulase-negative Staphylococcus (n = 6), Clostridium (n = 1), and Corynebacterium (n = 1). Of all positive cultures, 15 were obtained from the anterior location (65%), of which seven (60%) were from the most proximal biopsy location. However, these findings were not statistically significant (anterior vs lateral, p = 0.076; proximal vs distal, p =0.238).
Conclusion:
Approximately 14% (14/101) of the patients demonstrated a positive Cutibacterium colonization about the hip, the majority anteriorly. Given the high colonization rate of Cutibacterium, alternative skin preparations for total hip arthroplasty should be considered. Cite this article: Bone Joint J 2020;102-B(7 Supple B):52-56.
Insights
Approximately 14% of patients undergoing hip surgery showed Cutibacterium colonization, primarily on the anterior skin. This highlights the need for improved skin preparation protocols in total hip arthroplasty to prevent atypical infections.
Area of Science:
- Microbiology
- Orthopedic Surgery
- Infectious Disease
Background:
- Atypical infections, particularly Cutibacterium (formerly Propionibacterium) species, are an emerging concern in arthroplasty.
- The dermal colonization rate of Cutibacterium around the hip is not well-established.
Purpose of the Study:
- To investigate the colonization rates of Cutibacterium species at skin locations relevant to anterior and posterolateral hip approaches.
- To inform the development of improved skin preparation techniques for hip arthroplasty.
Main Methods:
- 101 adult patients undergoing hip or knee surgery were enrolled in a non-randomized, non-blinded study.
- Four 3 mm dermal punch biopsies were collected from anterior and lateral hip locations prior to surgery.
- Samples were cultured using a protocol optimized for Cutibacterium, with standardized skin preparation including chlorhexidine and isopropyl alcohol.
Main Results:
- Overall, 22% of patients had positive cultures for microorganisms; 14% were positive for Cutibacterium species (predominantly Cutibacterium acnes).
- Cutibacterium colonization was observed more frequently at the anterior hip location (15% of patients), though not statistically significant.
- Other isolated microorganisms included coagulase-negative Staphylococcus, Clostridium, and Corynebacterium.
Conclusions:
- A significant proportion of patients (14%) exhibit Cutibacterium colonization on the hip, with a tendency towards anterior locations.
- The findings suggest that current skin preparation protocols may be insufficient to eliminate Cutibacterium colonization.
- Alternative or enhanced skin preparation strategies should be considered for total hip arthroplasty to mitigate the risk of atypical infections.
More Related Videos
08:31Candida albicans Biofilm Development on Medically-relevant Foreign Bodies in a Mouse Subcutaneous Model Followed by Bioluminescence Imaging
Published on: January 27, 2015
03:53Growing a Cystic Fibrosis-Relevant Polymicrobial Biofilm to Probe Community Phenotypes
Published on: April 19, 2024
Related Concept Videos
01:30Bacterial Phylum Actinobacteria
01:18Surface Membrane Barriers
The outer layer of the skin, the epidermis, is a robust barrier comprising layers of closely packed keratinized cells. This dense arrangement prevents microbes from penetrating the body. The periodic shedding of epidermal cells...
01:25Urinary Tract Infection II: Pathophysiology
01:20Muscles that Move the Thigh
Three other significant muscles are the gluteus maximus, gluteus medius, and gluteus minimus. The gluteus maximus originates from the posterior surface of the ilium, sacrum, and coccyx, and the thoracolumbar...
01:23Muscles that Move the Leg
Anterior Compartment
The quadriceps femoris, the most visible muscle of the anterior compartment, is integral for leg extension and thigh flexion. It is formed by merging four distinct muscles — the vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris. The quadriceps tendon, a shared tendon of the four quadriceps muscles, is affixed...
01:29Bacterial Flora of the Large Intestine
The normal gut flora of the colon plays a critical role in generating essential vitamins such as vitamins K, B5, and B7.