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MRSA Implicated in Majority of Post-Facelift Infections 3-18-08
NEW YORK, March 18 -- Although surgical-site infections after face-lift
procedures are uncommon, those that occur are often caused by methicillin-resistant
Staphylococcus aureus, making them difficult to treat.
Surgical-site infections developed in 0.6% of patients who underwent deep-plane
rhytidectomy, but 80% tested positive for MRSA according to a retrospective,
single-center study reported by Richard A. Zoumalan, M.D., and David B.
Rosenberg, M.D., both of the Lennox Hill-Manhattan Eye, Ear, and Throat Hospital
here, in the March/April issue of the Archives of Facial Plastic Surgery.
"For surgical site infections, the facial plastic surgeon should have a high
suspicion for MRSA as the causative pathogen," the researchers wrote.
MRSA has become the leading causative pathogen in surgical-site, skin, and soft
tissue infections. It is also more virulent, costs approximately $3,700 more to
treat, and has three times the mortality rate of methicillin-sensitive S. aureus,
they noted.
The only study of surgical-site infection rates for face-lift surgery, though,
was done more than 10 years ago before the rise of community-acquired MRSA.
The researchers reviewed charts of 780 consecutive patients who underwent
deep-plane rhytidectomy from January 2001 to January 2007 by a single surgeon at
the same outpatient surgical center.
Cases of revision rhytidectomy were included and patients could also have
undergone other procedures, including blepharoplasty, browpexy, rhinoplasty,
autologous fat transfer, laser resurfacing, and chemical peel.
To prevent infection, patients showered and washed their hair with chlorhexidine
solution on the morning of surgery. After induction of anesthesia but before
incision, their faces were scrubbed with chlorhexidine (Peridex, Periogard) and
povidone-iodine and they were given 1 g of intravenous cefazolin sodium (Ancef).
After surgery, patients received seven days of prophylactic antibiotics with
oral cefadroxil (Duricef).
Even so, five patients overall developed a postoperative wound infection (0.6%).
Four of the patients with a postoperative wound infection had cultures tested
positive for MRSA (0.5% of the total).
Two of the infected patients required hospitalization for intravenous antibiotic
therapy (0.3% of the total). Both had MRSA with potential exposure to MRSA
preoperatively.
One of these patients spent about 10 days visiting her spouse in the cardiac
intensive care unit four months prior to her operation. The other patient
frequently saw her brother-in-law, who is a cardiologist.
This "stresses the importance of hospital and physician-related contacts in
history taking," the researchers said. Other factors that should be considered
during history taking include recent antimicrobial therapy and previous MRSA
colonization, they said.
However, all patients had minimal to no scarring after the infection and wound
healed.
These rates of surgical-site infection were similar to those in the only prior
study looking at rates after face lift (0.18% versus 0.3% for hospitalization).
Although all four MRSA-infected patients were sensitive to
trimethoprim-sulfamethoxazole (Septra or Bactrim) and vancomycin (Vancocin), all
were resistant to erythromycin. Only one was sensitive to clindamycin (Cleocin,
Clinda-Derm), and one was sensitive to ciprofloxacin (Cipro).
Reason for the high proportion of MRSA infections compared with other pathogens
could include the aggressive nature of MRSA and the use of post-operative
antibiotics effective against methicillin-sensitive S. aureus, Drs. Zoumalan and
Rosenberg said.
"With the rise of MRSA colonization and infections," they said, "facial plastic
surgeons performing rhytidectomy and other soft tissue procedures may want to
consider introducing screening protocols to identify patients who are at
increased risk for infection."