AbstractCutibacterium acnesisolation from spine tissue can be challenging because the organism can
represent a contaminant. There is a paucity of data regarding the role ofC. acnesin non-hardware-associated vertebral osteomyelitis (VO). Herein we
evaluate the clinical and microbiological characteristics, treatment, and
outcome of patients withC. acnesVO. Data were retrospectively collected from
adults with a positive spine culture forC. acnesat Mayo Clinic, Rochester (MN),
from 2011 to 2021. Patients with spinal hardware and polymicrobial
infections were excluded. Of the subjects, 16 showed radiological and
clinical findings of VO: 87.5 % were male, the average age was 58 years
(±15SD), and back pain was the predominant symptom. Of the lesions, 89.5 % involved the thoracic spine. Of the subjects, 69 % had experienced an antecedent
event at the site of VO. In five subjects,C. acneswas isolated after 7 d of anaerobic culture incubation. Thirteen subjects were treated with parenteralβ-lactams, and three with oral antimicrobials, without any evidence
of recurrence. Twenty-one subjects were not treated for VO, asC. acneswas
considered a contaminant; at follow-up, none had evidence of progressive
disease.C. acnesshould be part of microbiological differential diagnosis in
patients with suspected VO, especially in the context of a prior spinal
procedure. Anaerobic spine cultures should undergo prolonged incubation to
enable recovery ofC. acnes.C. acnesVO may be managed with oral or parenteral
antimicrobial therapy. Without clinical and radiological evidence of VO, a
single positive culture ofC. acnesfrom spine tissue frequently represents
contaminants.