A 45-year-old female patient with hypothyroidism underwent liposuction with autologous fat grafting to the thighs. In the immediate postoperative period, she developed deep vein thrombosis in the left lower limb, and anticoagulation with enoxaparin was initiated at home. She progressed with edema and progressive hyperemia in the fat grafting regions and was admitted with suspected surgical site infection. Magnetic resonance imaging of the thighs revealed muscle infiltration with collections in the quadriceps, predominantly on the right side, suggesting an ischemic process with possible superimposed infection. Empirical treatment with cefepime and daptomycin was initiated, and the orthopedic team indicated surgical debridement due to suspected pyomyositis. However, a minimally invasive ultrasound-guided drainage was chosen. Culture of the drained secretion identified Cutibacterium avidum as the etiological agent. Cutibacterium avidum is a Gram-positive, anaerobic–aerotolerant bacillus, a member of the human skin microbiota 1, with tropism for moist areas and pilosebaceous follicles. Recently, it has been implicated in implant-associated infections and is currently recognized as an etiological agent of surgical site infections, with reports of resistance to surgical antisepsis. Despite the high prevalence of aesthetic surgeries, reports of C. avidum infections in this context remain rare or underreported. To date, there is no gold standard for the treatment of Cutibacterium infections. Studies demonstrate that C. avidum remains highly susceptible to a broad spectrum of antibiotics, such as β-lactams, fluoroquinolones, macrolides, and rifampicin. Shah et al. proposed therapeutic regimens for prosthetic joint–related infections, recommending penicillin (20–24 million units/day) or ceftriaxone (2 g/day), both intravenously, as first-line therapy. As second-line therapy, clindamycin (600–900 mg IV every 8 hours) or vancomycin (15 mg/kg IV every 12 hours) are suggested. In cases of abscesses, initial surgery with extensive debridement should be performed, and treatment for 2 to 4 weeks appears to be associated with favorable outcomes.
Mussi et al. (Sun,) studied this question.