### Microbiology *[[Cutibacterium]]* are anaerobic gram-positive rod, formally known as *[[Propionibacterium]]*. I do not know if that is an improvement for spelling or pronunciation. *C*. acnes. As of 2018, [^1] *C*. *humerusii*, *C*. *namnetense*, *C*. *acnes**C*. *avidum*, *C*. *granulosum* are all now *[[Cutibacterium]]*. > "As an aside, the authors who proposed the novel genus name [[Cutibacterium]] stated that the name should be pronounced "cootie" or koo-tee, as in a child's term for an imaginary---or real---germ." ### Epidemiologic Risks *[[Cutibacterium]]* lives in hair follicles, sweat and sebaceous glands, an environment that protects it from both topical and systemic antibiotics. [^2] *C*. *avidum* lives in the groin of obese patients and from there it infects prosthetic hips. [^3] ### Syndromes Often a contaminant in the spinal tap that grows on day 5 in the thioglycolate culture only. If cultured anaerobically, *[[Cutibacterium]]* *acnes* may account for 15% of [[Catheter Infections]]. [^4] Post-op wound infections where there is hair, often associated with devitalized tissue or prosthetic material. There can be months between the surgery and the clinical manifestation of the disease. Given its association with hair, it is found as a problem with neurosurgical operations: VP shunts, laminectomy infections, craniotomy infections, [[Discitis]] are commoner manifestations. *De* *novo* infected discs can have anaerobes, including *C*. *acnes*. If the MRI is the right type (disc herniation with Modic Type 1), the herniated disc may indeed be infected, [^5] although not supported in all studies, as is so often the case ([PubMed](http://www.ncbi.nlm.nih.gov/pubmed/26818032)). [^6] Me? I thought the infection was legit. *[[Cutibacterium]]* *acnes* may be a cause of [[Prosthetic Joint Infections]], [^7] especially after shoulder surgery. [^8]My son, at this writing six years old, uses the word worser; I have taken the liberty of extending the neologism. Perhaps because it is normal flora, the usual inflammatory markers may be normal. Make sure the lab knows and holds the cultures for longer than the usual 5 days; it often doesn't grow until after day 7. The odd infection associated with other hardware, like fractures. Occasional [[endocarditis]], usually a prosthetic valve; I have seen two. Often prosthetic valves in men (the furry gender) often require valve surgery. [^9] In a series of 522 patients with *C*. *acnes* bacteremia, 3.5% of isolates turned out to be significant. [^11] I do not think I have seen one, much less 522. It makes one wonder about their blood culture technique, or perhaps it was an adolescent hospital. *C*. *acnes* may cause/be associated with the SAPHO syndrome (seronegative [[arthritis]] associated with skin manifestations and to show synovitis, [[Acne]], pustulosis, hyperostosis, and osteitis with and without sterile multifocal [[osteomyelitis]]. Sounds unpleasant) and treatment decreases symptoms. *C*. *avidum* associated with [[Prosthetic Joint Infections]]. [^10] ### Treatment Penicillin OR [[clindamycin]]. In the test tube, the best killing occurs with a combination of [[vancomycin]] PLUS [[ceftriaxone]]. ### Notes Although I often say the three most dangerous words in medicine are "In my experience", in my experience [[clindamycin]] works better. So there. BTW. It is usually resistant to [[metronidazole]]. My record has been 7 years between the craniotomy and a symptomatic subdural [[empyema]]. That duration is not unusual in the literature. *[[Cutibacterium]]* *freudenreichii* subsp. *shermanii* is used in cheese-making to create CO2 bubbles that become the round holes in Swiss cheese. ### Puswhisperers [My Awsomeness Recognized](http://www.pusware.com/PW1/M[[Yaws]]omenessRecognized.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop90.mp3) [More than zits](http://www.pusware.com/PW2/MorethanZits.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop721.mp3) [Metastatic Zits](http://www.pusware.com/PW2/MetastaticZits.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop240.mp3) [Unexpecting the Unexpected](http://www.pusware.com/PW3/UnexpectingtheUnexpected.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop415.mp3) [3640 days later](http://www.pusware.com/PW3/3640dayslater.html) [Audio. 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The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop1233.mp3) [Hard to Ignore](http://www.pusware.com/PW12/HardToIgnore.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop1306.mp3) ### Rationalizations [^1]: Scholz CFP, Kilian M. The natural history of cutaneous propionibacteria, and reclassification of selected species within the genus [[Propionibacterium]] to the proposed novel genera Acidipropionibacterium gen. nov., [[Cutibacterium]] gen. nov. and Pseudopropionibacterium gen. nov. Int J Syst Evol Microbiol. 2016 Nov;66(11):4422-4432. doi: 10.1099/ijsem.0.001367. Epub 2016 Aug 2. PMID: 27488827. [^2]: Matsen FA 3rd, Butler-Wu S, Carofino BC, Jette JL, Bertelsen A, Bumgarner R. Origin of [[Propionibacterium]] in surgical wounds and evidence-based approach for culturing [[Propionibacterium]] from surgical sites. J Bone Joint Surg Am. 2013 Dec 4;95(23):e1811-7. doi: 10.2106/JBJS.L.01733. PMID: 24306704; PMCID: PMC4098017. [^3]: Böni L, Kuster SP, Bartik B, Zbinden R, Zingg PO, Achermann Y. Association of [[Cutibacterium]] avidum Colonization in the Groin With Obesity: A Potential Risk Factor for Hip Periprosthetic Joint Infection. Clin Infect Dis. 2018 Nov 28;67(12):1878-1882. doi: 10.1093/cid/ciy379. PMID: 29746626. [^4]: Böni L, Kuster SP, Bartik B, Zbinden R, Zingg PO, Achermann Y. Association of [[Cutibacterium]] avidum Colonization in the Groin With Obesity: A Potential Risk Factor for Hip Periprosthetic Joint Infection. Clin Infect Dis. 2018 Nov 28;67(12):1878-1882. doi: 10.1093/cid/ciy379. PMID: 29746626. [^5]: Urquhart DM, Zheng Y, Cheng AC, Rosenfeld JV, Chan P, Liew S, Hussain SM, Cicuttini FM. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med. 2015 Jan 22;13:13. doi: 10.1186/s12916-015-0267-x. PMID: 25609421; PMCID: PMC4320560. [^6]: Rigal J, Thelen T, Byrne F, Cogniet A, Boissière L, Aunoble S, Le Huec JC. Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in lumbar spine. Eur Spine J. 2016 Apr;25(4):1000-5. doi: 10.1007/s00586-016-4396-5. Epub 2016 Jan 27. PMID: 26818032. [^7]: Zeina A. Kanafani, Daniel J. Sexton, Brian C. Pien, Jay Varkey, Carl Basmania, Keith S. Kaye, Postoperative Joint Infections Due to _Propionibacterium_ Species: A Case-Control Study, _Clinical Infectious Diseases_, Volume 49, Issue 7, 1 October 2009, Pages 1083–1085, [https://doi.org/10.1086/605577](https://doi.org/10.1086/605577) [^8]: Levy PY, Fenollar F, Stein A, Borrione F, Cohen E, Lebail B, Raoult D. [[Propionibacterium]] acnes postoperative shoulder [[arthritis]]: an emerging clinical entity. Clin Infect Dis. 2008 Jun 15;46(12):1884-6. doi: 10.1086/588477. PMID: 18462110. [^9]: Lindell F, Söderquist B, Sundman K, Olaison L, Källman J. Prosthetic valve [[endocarditis]] caused by [[Propionibacterium]] species: a national registry-based study of 51 Swedish cases. Eur J Clin Microbiol Infect Dis. 2018 Apr;37(4):765-771. doi: 10.1007/s10096-017-3172-8. Epub 2018 Jan 29. PMID: 29380224; PMCID: PMC5978902. [^10]: Achermann Y, Liu J, Zbinden R, Zingg PO, Anagnostopoulos A, Barnard E, Sutter R, Li H, McDowell A, Zinkernagel AS. [[Propionibacterium]] avidum: A Virulent Pathogen Causing Hip Periprosthetic Joint Infection. Clin Infect Dis. 2018 Jan 6;66(1):54-63. doi: 10.1093/cid/cix665. PMID: 29020266; PMCID: PMC5850018.