The relevance of Cutibacterium spp. in neurosurgical practice

This review presents literature data on the morphology and virulence factors of Cutibacterium spp. anaerobes, paying special attention to their ability to form biofilms. Exposure to Cutibacterium spp. occurs most commonly due to inadequate asepsis during surgical incision, as well as exogenous skin microbiota or hematogenous introduction through the bloodstream after insertion of a medical device. If an implant-associated infection is suspected in a patient, the surgeon should take at least three tissue samples for microbiological examination from different parts of the peri-implant area, stopping antimicrobial therapy 2 weeks prior to sampling. When removing the implant, it is recommended to pre-treat the samples in an ultrasonic bath. Considering the difficulty of culturing anaerobic microorganisms, our bacteriological department of the Federal Center for Neurosurgery (FCN) has proposed vials with two-phase medium (Two-phase system HiCombi, Himedia) for the isolation of Cutibacterium spp. For quick and easy identification of Cutibacterium spp. the optimal analyzer is the MALDI-TOF MS. In the period from 2017 through 2020, the bacteriological department of the FCN carried out the analysis of various biomaterial obtained from patients, in which the main isolation of gram-positive bacilli from the separated wounds, cerebrospinal fluid and intraoperative material was recorded. A higher percentage of isolation was shown in liquor and intraoperative material, which can be explained by the use of various metal structures and liquor shunts by the FCN. Since the infection caused by Cutibacterium spp. often progresses slowly, the recommended treatment is extensive and aggressive sanation of all infected tissue with implant removal, and surgical treatment should be accompanied by long-term antibiotic treatment. It should be noted that for a more accurate diagnosis, the results of bacteriologic studies should be interpreted in conjunction with the clinical data of the patient, in the presence of typical signs of infection, the isolation of Cutibacterium spp. from two or more samples should be considered as a pathogen rather than contamination. The presence of foreign materials increases the pathogenicity of these microorganisms.