Cutibacterium acnes clonal complexes display various growth rates in blood culture bottles used for diagnosing orthopedic device related infections

Blood-culture bottles (BCBs) are widely used to improve the diagnosis of orthopedic device-related infections. Data is scarce on the growth of Cutibacterium acnes and its genotypes in BCBs under real-life clinical conditions. We studied 39 cases of revision arthroplasty for which at least one intraoperative sample yielded a pure C. acnes culture from anaerobic BCBs (BD Bactec Lytic/10 Anaerobic/F [Lytic Ana]) and/or solid media. Genotyping of C. acnes isolates from the 39 cases allowed: i) the identification of 49 non-redundant isolates belonging to four clonal complexes (CCs): CC18, CC28, CC36, and CC53 and ii) the determination of infectant and contaminant strains. Under real-life clinical conditions, Lytic Ana alone was more often positive for contaminants than infectant strains (18/36 [50%] versus 2/13 [15.4%]; p = 0.047). The time to detection (TTD) values in Lytic Ana were shorter for CC53 than other CCs (mean [SD] TTD: 77 [15] versus 165 [71] hours; p = 0.02). CC53 was confirmed to grow faster than other CCs by studying an enlarged panel of 70 genotyped C. acnes strains inoculated in vitro into Lytic Ana vials (mean [SD] TTD: 73 [13] versus 122 [50] hours; p < 0.001). The use of Lytic Ana BCBs in orthopedics increases the recovery rate of C. acnes but leads to the isolation of proportionally more contaminants than true infectant strains. TTD values are much shorter for CC53 strains, irrespective of their being infectant or contaminant. TTD does not solely reflect the bacterial load of samples but also clonal complex-related traits.