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Updated: Nov 19, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Cutibacterium avidum resists surgical skin antisepsis in the groin-a potential risk factor for periprosthetic joint
Steven M Maurer1, Laura Kursawe2, Stefan Rahm3
1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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.
Insights
Standard skin antisepsis before hip replacement surgery is not fully effective against Cutibacterium avidum, a bacteria linked to periprosthetic joint infections. Further research is needed for better prevention strategies.
Area of Science:
- Microbiology
- Infectious Diseases
- Surgical Site Infections
Background:
- Cutibacterium avidum (C. avidum) is an emerging pathogen causing periprosthetic joint infections (PJI).
- Early PJIs are often attributed to skin commensals contaminating surgical sites.
- The efficacy of standard skin antisepsis against C. avidum colonization requires investigation.
Purpose of the Study:
- To evaluate the effectiveness of standard povidone-iodine/alcohol skin antisepsis.
- To determine if antisepsis eliminates skin-colonizing C. avidum before total hip arthroplasty (THA).
Main Methods:
- Prospective, single-center study screening patients for C. avidum colonization.
- Preoperative skin swabs and dermis biopsies for microbiology and FISH analysis.
- Assessment of C. avidum elimination after antisepsis and antibiotic prophylaxis.
Main Results:
- 85% of patients (51/60) had skin bacteria colonization; 20% (12/60) were colonized with C. avidum.
- Skin antisepsis eliminated C. avidum in only 20% (8/10) of colonized patients.
- FISH detected C. avidum in one dermis biopsy near sweat glands, despite negative cultures.
Conclusions:
- Standard skin antisepsis is insufficient to eradicate C. avidum colonization.
- C. avidum colonization may increase the risk of THA-associated PJI.
- Development of novel, more effective antisepsis strategies is necessary.
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