About one-half percent of patients undergoing facelift surgery at one outpatient surgical center between 2001 and 2007 developed methicillin-resistant Staphylococcus aureus (MRSA) infections, according to a report in the March/April issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
MRSA is now a leading cause of infections at surgical sites and in skin and soft tissues, according to background information in the article. It is much more virulent than other forms of staph infection, spreads through tissue more rapidly, is more difficult to control and causes infections that are more expensive to treat and are associated with higher death rates.
Richard A. Zoumalan, M.D., of Lennox Hill-Manhattan Eye, Ear, and Throat Hospital and New York University School of Medicine, New York, and David B. Rosenberg, M.D., also of Lennox Hill-Manhattan Eye, Ear, and Throat Hospital, reviewed the charts of 780 patients who underwent facelifts between 2001 and 2007. Of those, five (0.6 percent) developed surgical site infections, and four of those (0.5 percent of the total) tested positive for MRSA. All of the infections occurred in 2006.
"The high proportion of MRSA infections compared with other pathogens is likely attributable to a combination of factors," the authors write. MRSA is an aggressive pathogen more likely to complicate surgical sites, and the antibiotic typically prescribed following surgery is effective against other types of bacteria. "For surgical site infections, the facial plastic surgeon should have a high suspicion for MRSA as the causative pathogen," they continue.
Of the four patients with MRSA-positive infections, two were admitted to the hospital for intravenous antibiotic therapy. Both had potential exposure to MRSA before surgery. One had spent time with her spouse in the cardiac intensive care unit four months prior and the other had frequent contact with her brother-in-law, a cardiologist.
"With the rise of MRSA colonization and infections, facial plastic surgeons performing rhytidectomy [facelift] and other soft tissue procedures may want to consider introducing screening protocols to identify patients who are at increased risk for infection," the authors write. "During preoperative evaluation, a full medical history should include information on possible prior contacts with persons at high risk for carrying MRSA." Other significant risk factors include recently having taken antibiotics or having been hospitalized, contact with health care workers, previous MRSA infections, older age, diabetes, smoking and obesity.
"Because the medical, psychological and cosmetic sequelae of wound infections can be devastating, every appropriate step should be used to prevent wound infections in facial plastic surgery," the authors write. This includes proper hand-washing between patients and preventive courses of antibiotics.
(Arch Facial Plast Surg. 2008;10:116-123. Available pre-embargo to the media at www.jamamedia.org.)
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