Infection and Drug Resistance (Feb 2019)
Treatment of late bacterial infections resulting from soft-tissue filler injections
Abstract
Wojciech Marusza,1 Romuald Olszanski,2 Janusz Sierdzinski,3 Tomasz Ostrowski,4 Kamila Szyller,1 Grazyna Mlynarczyk,5 Irina Netsvyetayeva5 1Academy of Face Sculpting, Warsaw, Poland; 2Military Institute of Health Services, Warsaw, Poland; 3Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland; 4Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland; 5Department of Microbiology, Medical University of Warsaw, Warsaw, Poland Purpose: Late bacterial infections (LBIs) after esthetic facial augmentation using hyaluronic acid (HA) fillers are relatively rare yet severe complications that are difficult to treat. No adequate treatment standards have hitherto been formulated. We have bridged this gap by formulating a treatment scheme based on the principles of treating foreign-body implantation-related infections and treating bacterial growth in the form of biofilm. The objective of this study was to evaluate the efficacy of a comprehensive scheme for treating LBI complications after facial augmentation using cross-linked HA fillers. Methods: A total of 22 patients with LBI symptoms at a site of cross-linked HA injection underwent treatment and observation. The comprehensive treatment scheme formulated by Marusza and Netsvyetayeva (M&N scheme) comprised draining the lesion, dissolution of cross-linked HA with hyaluronidase, broad-spectrum antibiotic combination therapy, and use of probiotics. While 17 patients underwent the M&N scheme, the remaining five were treated with other schemes. Statistical analysis of the data was performed using Mann–Whitney U and χ2 nonparametric tests with SAS 9.4 software. Results: All 17 patients who underwent the M&N scheme experienced resolution of symptoms, with no recurrence of infection at the HA-injection sites. Conclusion: To treat LBI at a site of cross-linked HA administration, the principles applicable to infections resulting from implantation of a foreign body must be followed. The treatment period should be sufficiently long for complete resolution of symptoms. The efficacy of treatment is considered proven if 2 months have elapsed without recurrence since the symptoms resolved. The M&N scheme is recommended for use as the first therapeutic option for treating LBI related to soft-tissue fillers. Keywords: bacterial biofilm, hyaluronic acid, soft-tissue filler complications, biofilm treatment