Post‑cranial Neurosurgery Cutibacterium acnes Infections - Clinical Correlates, Presentation, and Outcomes - A Matched Case–Case–Control Study

Sep 30, 2026

Although Cutibacterium acnes is viewed as a typical cause of postoperative central nervous system infections, its specific role as a pathogen and the related clinical patterns remain insufficiently characterized. A case–case–control study matched adults with monomicrobial C. acnes infections after nonspine neurosurgery to controls without infection and to cases with aerobic bacterial infections using age, year, and procedure type. Smoking emerged as the only independent risk factor for C. acnes infections, which often manifested as empyema, showed less fever, and had favorable 90-day outcomes compared with aerobic infections.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Introduction

Methods

Results

Conclusions

Key Summary Points

Why carry out this study?

What was learned from the study?

Background and Rationale

Infect Dis Ther (2026) 15:149–164 [https://doi.org/10.1007/s40121-025-01268-2](https://doi.org/10.1007/s40121-025-01268-2) ORIGINAL RESEARCH Post‑cranial Neurosurgery Cutibacterium acnes Infections: Clinical Correlates, Presentation, and Outcomes—A Matched Case–Case–Control Study Neta Shirin · Ofek Arviv · Karina Zinman · Bar Mizrahi · Yovel Peretz · Sarit Moshayev Revale · Idan Levitan · Elena Mishuk · Lior Ungar · Asaf Biber · Sharon Amit · Tal Zilberman‑Daniels · Zvi R. Cohen · Dafna Yahav · Ili Margalit Received: September 26, 2025 / Accepted: November 4, 2025 / Published online: November 14, 2025 © The Author(s) 2025 ABSTRACT Introduction: Although Cutibacterium acnes is considered a typical pathogen of postoperative central nervous system (CNS) infections, data on its role as a pathogen, remain limited. This study aimed to address this knowledge gap. Methods: A case–case–control study of adults with monomicrobial Cutibacterium acnes infec‑ tions (CaIs) following nonspine neurosurgical procedures (2016–2024) (Cases I) . These were individually matched (1:1:1) by age, year, and procedure type to individuals who did not develop infection (controls) and to individuals Supplementary Information The online version contains supplementary material available at [https://doi.org/10.1007/s40121](https://doi.org/10.1007/s40121)‑025‑01268‑2. N. Shirin (*) · A. Biber · D. Yahav · I. Margalit Infectious Diseases Unit, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel e‑[mail: netashirin@yahoo.com](mail: netashirin@yahoo.com) O. Arviv · B. Mizrahi · A. Biber · S. Amit · Z. R. Cohen · D. Yahav · I. Margalit School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel K. Zinman Department of Medicine F, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel Y. Peretz · S. M. Revale · A. Biber · I. Margalit Infection Control and Prevention Unit, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel with aerobic bacterial infections (abIs; cases II) . Multivariable conditional logistic regression models were implemented to assess clinical cor‑ relates for infection by either bacterial group, clinical presentation, and outcomes differences. Results: Cutibacterium acnes isolation pre‑ dominantly reflected contamination (131/213, 62%), and ultimately 32 (15%) CaIs cases were included. Smoking (adjusted odds ratio [aOR] 3.25, 95% confidence interval [CI] 1.06–9.97) was the only independent risk factor identified for CaIs. In contrast, nonelective procedure was identified as an independent risk factor for abIs (aOR 6.0, 95% CI 1.34–26.81, p = 0.019) . CaIs commonly involved empyema (84%[27/32] versus 53%[17/32] with abIs, p = 0.014) . Indi‑ viduals with CaIs tended to follow a relatively indolent clinical course, were less likely to I. Levitan Department of Neurosurgery, Rabin Medical Center, Beilinson Hospital, Petah‑Tikva, Israel E. Mishuk · L. Ungar · Z. R. Cohen Department of Neurosurgery, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel S. Amit · T. Zilberman‑Daniels Microbiology Laboratory, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel present with fever (aOR 0.15, 95% CI 0.04–0.68), and had favorable outcomes. When compared with CaIs, patients with abIs were less likely to achieve clinical cure at 90 days (aOR 0.02, 95% CI 0.001–0.41) . Conclusions: Although no modifiable risk factors were identified, CaIs frequently caused empyema, were less likely to present with fever, and were associated with a favorable prognosis. Keywords: Anaerobes; C. acnes; Central nervous system infections; Nosocomial infections Key Summary Points Why carry out this study? Cutibacterium acnes plays a pathogenic role in postcranial neurosurgery infections. How‑ ever, evidence regarding its specific clinical correlates, clinical syndrome, and outcomes remains limited. This was a case–case–control study of postcra‑ nial neurosurgery patients, comparing

FAQs

What was the main aim of the study on Cutibacterium acnes infections after neurosurgery?

To address limited evidence by defining clinical correlates, clinical presentation, and outcomes of Cutibacterium acnes infections following postcranial neurosurgical procedures.

How was the study designed and what groups were compared?

It used a case–case–control design in adults with monomicrobial Cutibacterium acnes infections, individually matched to controls without infection and to cases with aerobic bacterial infections by age, year, and procedure type.

What factors and clinical features were associated with Cutibacterium acnes infections?

Smoking was the only independent risk factor identified. Cutibacterium acnes infections commonly involved empyema, had an indolent course, were less likely to present with fever, and showed favorable outcomes.

Sep 30, 2026

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