Reporte de Caso

Cutibacterium acnes en infección de malla abdominal: un patógeno infradiagnosticado

Volumen XXX, Edición 3, Setiembre - Diciembre 2026

Publicación: 30-09-26

DOI: https://doi.org/10.55139/EYVK8057

Allan Robles Calderón
Departamento de Urgencias, Hospital Clínica Bíblica, San José, Costa Rica.

Monica Alfaro Rodríguez
Departamento de Atención Farmacéutica y Farmacia Clínica, Universidad de Costa Rica San José, Costa Rica.

Resumen

Introducción: Cutibacterium acnes es un comensal habitual de la piel que puede actuar como patógeno oportunista en infecciones asociadas a material protésico. Su crecimiento lento, capacidad de formar biofilm y frecuente interpretación como contaminante dificultan establecer su relevancia clínica. Caso clínico: Se presenta el caso de un hombre de 54 años con hipertensión arterial, diabetes mellitus tipo 2 y dislipidemia, sometido a hernioplastia abdominal con colocación de malla. Once días después reingresó por abundante secreción de la herida quirúrgica y recurrencia de la hernia, con proteína C reactiva de 117 mg/L. Se inició tratamiento empírico con cefepime y linezolid y se realizó control quirúrgico del foco con retiro del material protésico. Los cultivos de secreción y muestras posteriores mostraron repetidamente Staphylococcus aureus resistente a meticilina, mientras que un cultivo anaerobio de un absceso profundo permitió identificar adicionalmente C. acnes. Durante la hospitalización se realizaron lavados quirúrgicos seriados y terapia de presión negativa. La PCR disminuyó progresivamente hasta 3,95 mg/L antes del egreso y en el seguimiento no se documentaron signos clínicos de infección. Conclusión: El aislamiento de C. acnes en una muestra profunda asociada a material protésico no debe descartarse automáticamente como contaminación; sin embargo, un aislamiento único tampoco permite establecer causalidad. Su interpretación requiere integración clínica, microbiológica y quirúrgica, junto con un adecuado control del foco.

Palabras claves

Cutibacterium acnes; malla quirúrgica; infección relacionada con prótesis; infección de la herida quirúrgica; biofilm; Staphylococcus aureus resistente a meticilina.

Abstract

Background: Cutibacterium acnes is a common skin commensal that can act as an opportunistic pathogen in infections associated with prosthetic material. Its slow growth, biofilm-forming capacity, and frequent interpretation as a contaminant make its clinical significance difficult to establish. Case presentation: We report the case of a 54-year-old man with hypertension, type 2 diabetes mellitus, and dyslipidemia who underwent abdominal hernia repair with prosthetic mesh placement. Eleven days after surgery, he was readmitted with abundant surgical wound drainage and hernia recurrence, with a C-reactive protein level of 117 mg/L. Empirical antimicrobial therapy with cefepime and linezolid was initiated, together with surgical source control and removal of the prosthetic material. Cultures from the wound and subsequent specimens repeatedly yielded methicillin-resistant Staphylococcus aureus, whereas anaerobic culture of a surgically obtained deep abscess additionally identified C. acnes. Serial surgical washouts and negative-pressure wound therapy were performed. C-reactive protein progressively decreased to 3.95 mg/L before discharge, and no clinical signs of infection were documented at follow-up. Conclusion: Isolation of C. acnes from a deep specimen associated with prosthetic material should not be automatically dismissed as contamination; however, a single positive culture does not establish causality. Interpretation requires integration of clinical, microbiological, and surgical findings, together with appropriate source control.

Keywords

Cutibacterium acnes; surgical mesh; prosthesis-related infections; surgical wound infection; biofilms; methicillin-resistant Staphylococcus aureus.

Referencias

1. [Internet]. [cited 2026 Sep 1]. Available from: https:// pmc.ncbi.nlm.nih.gov/articles/PMC9021144/

2. Environmental, Microbiological, and Immunological Features of Bacterial Biofilms Associated with Implanted Medical Devices - PMC [Internet]. [cited 2026 Sep 1]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/ PMC8768833/

3. Medical Device-Associated Infections Caused by Biofilm-Forming Microbial Pathogens and Controlling Strategies [Internet]. [cited 2026 Sep 1]. Available from: https:// www.mdpi.com/2079-6382/13/7/623

4. Broly M, Ruffier d’Epenoux L, Guillouzouic A, Le Gargasson G, Juvin ME, Leroy AG, et al. Propionibacterium/ Cutibacterium species–related positive samples, identification, clinical and resistance features: a 10-year survey in a French hospital. Eur J Clin Microbiol Infect Dis. 2020;39:1357–64. doi:10.1007/s10096-020-03852-5

5. True infection or contamination in patients with positive Cutibacterium blood cultures—a retrospective cohort study | European Journal of Clinical Microbiology G Infectious Diseases | Springer Nature Link [Internet]. [cited 2026 Sep 7]. Available from: https://link.springer. com/article/10.1007/s10096-022-04458-9

6. Skin dysbiosis and Cutibacterium acnes biofilm in inflammatory acne lesions of adolescents | Scientific Reports [Internet]. [cited 2026 Sep 7]. Available from: https://www.nature.com/articles/s41598-022-25436-3

7. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM) * | Clinical Infectious Diseases | Oxford Academic [Internet]. [cited 2026 Sep 10]. Available from: https://academic.oup.com/ cid/advance-article/doi/10.1093/cid/ciae104/7619499

8. Gharamti AA, Kanafani ZA. Cutibacterium (formerly Propionibacterium) acnes infections associated with implantable devices. Expert Rev Anti Infect Ther. 2017;15:1083–94. doi:10.1080/14787210.2017.1404452
PubMed PMID: 29125405.

9. Aubin GG, Baud’huin M, Lavigne JP, Brion R, Gouin F, Lepelletier D, et al. Interaction of Cutibacterium ( formerly Propionibacterium) acnes with bone cells: a step toward understanding bone and joint infection development. Sci Rep. 2017;7:42918. doi:10.1038/ srep42918

10. Both A, Huang J, Hentschke M, Tobys D, Christner M, Klatte TO, et al. Genomics of Invasive Cutibacterium acnes Isolates from Deep-Seated Infections. Microbiol Spectr. 2023;11:e0474022. doi:10.1128/spectrum.04740-22
PubMed PMID: 36976006; PubMed Central PMCID: PMC10100948.

11. True infection or contamination in patients with positive Cutibacterium blood cultures—a retrospective cohort study | European Journal of Clinical Microbiology G Infectious Diseases | Springer Nature Link [Internet]. [cited 2026 Sep 10]. Available from: https://link.springer.com/article/10.1007/s10096-022-04458-9

12. Céline M, Jennifer VS, Xavier O, Baptiste F, Sophie G, Lukshe K, et al. Unraveling the Enigmatic Behavior of Cutibacterium acnes: Exploring Clinical Correlations and Behaviors of Clinical Strains in Prosthetic Joint Infections. Int J Microbiol. 2026;2026:8475639. doi:10.1155/ ijm/8475639 PubMed PMID: 41798862; PubMed Central PMCID: PMC12963669.

13. Tyner H, Patel R. Propionibacterium acnes biofilm – A sanctuary for Staphylococcus aureus? Anaerobe. 2016;40:63–7. doi:10.1016/j.anaerobe.2016.05.014

14. Abbott C, Grout E, Morris T, Brown HL. Cutibacterium acnes biofilm forming clinical isolates modify the formation and structure of Staphylococcus aureus biofilms, increasing their susceptibility to antibiotics. Anaerobe. 2022;76:102580. doi:10.1016/j.anaerobe.2022.102580 PubMed PMID: 35598875.

15. Khassebaf J, Hellmark B, Davidsson S, Unemo M, Nilsdotter-Augustinsson Å, Söderquist B. Antibiotic susceptibility of Propionibacterium acnes isolated from orthopaedic implant-associated infections. Anaerobe. 2015;32:57–62. doi:10.1016/j.anaerobe.2014.12.006

16. Tebruegge M, Jones C, de Graaf H, Sukhtankar P, Allan RN, Howlin RP, et al. Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome. Eur J Clin Microbiol Infect Dis. 2015;34:527–34. doi:10.1007/ s10096-014-2256-y PubMed PMID: 25326276.