Post-cranial Neurosurgery Cutibacterium acnes Infections: Clinical Correlates, Presentation, and Outcomes-A Matched...

Area of Science:

• Neurosurgery
• Infectious Diseases
• Microbiology

Background:

• Cutibacterium acnes is a known pathogen in CNS infections, but its specific role requires further investigation.
• Limited data exists on the clinical characteristics and outcomes of Cutibacterium acnes infections following neurosurgical procedures.

Purpose of the Study:

• To investigate the role of Cutibacterium acnes as a pathogen in postoperative central nervous system (CNS) infections.
• To compare clinical correlates, presentation, and outcomes of Cutibacterium acnes infections (CaIs) with aerobic bacterial infections (abIs) and uninfected controls.

Main Methods:

• A case-case-control study involving adults undergoing non-spine neurosurgery from 2016-2024.
• Matching of CaIs cases (Cases I) 1:1:1 with controls and aerobic bacterial infection cases (abIs; Cases II) by age, year, and procedure.
• Multivariable conditional logistic regression to identify risk factors, clinical features, and outcomes.

Main Results:

• Cutibacterium acnes isolation often represented contamination (62%); 32 CaIs cases were confirmed.
• Smoking was the only independent risk factor for CaIs (aOR 3.25), while nonelective procedures increased abI risk (aOR 6.0).
• CaIs frequently led to empyema (84%), presented with less fever (aOR 0.15), and showed favorable outcomes, with higher 90-day cure rates than abIs.

Conclusions:

• Cutibacterium acnes infections post-neurosurgery, though rare, commonly cause empyema.
• These infections are characterized by a less febrile presentation and a favorable prognosis.
• No modifiable risk factors were identified, but smoking is linked to CaIs.