MRSA is involved in the majority of post-facelift infections

NEW YORK, March 18 — Although surgical site infections after facelift procedures are uncommon, those that do occur are often caused by methicillin-resistant Staphylococcus disease, making them difficult to deal with.

Surgical site infections developed in 0.6% of patients undergoing deep rhytidectomy, but 80% tested positive for MRSA according to a retrospective, single-center study reported by Richard A. Zoumalan, MD, and David B .Rosenberg, MD, both of Lennox Hill-Manhattan Eye, Ear, and Throat Hospital here, in the March/April issue of Facial Plastic Surgery Archive.

“For surgical site infections, the facial plastic surgeon should have a high suspicion of MRSA as the causative pathogen,” the researchers wrote.

MRSA has become the main causative pathogen in surgical site, skin and soft tissue infections. It’s also more virulent, costs about $3,700 more to treat, and has three times the fatality rate of methicillin-susceptible S. aureusthey noted.

The only study of surgical site infection rates for facelift surgery, however, was done more than 10 years ago before the rise of community-acquired MRSA.

The researchers reviewed the charts of 780 consecutive patients who underwent deep rhytidectomy from January 2001 to January 2007 by a single surgeon at the same outpatient surgery center.

Cases of revision rhytidectomy were included, and patients could also have undergone other procedures, including blepharoplasty, rhinoplasty, rhinoplasty, autologous fat transfer, laser resurfacing, and chemical peels.

To prevent contamination, patients showered and washed their hair with a chlorhexidine solution on the morning of surgery. After induction of anesthesia but before incision, their faces were cleansed with chlorhexidine (Peridex, Periogard) and povidone-iodine, and 1 g of intravenous cefazolin sodium (Ancef) was administered.

After surgery, patients received seven days of prophylactic antibiotic therapy with oral cefadroxil (Duricef).

Even so, five patients developed a total of postoperative wound infection (0.6%). Four of the patients with postoperative wound infection had positive cultures 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 possible exposure to MRSA preoperatively.

One of these patients spent about 10 days visiting her husband in the cardiac intensive care unit four months before her surgery. The other patient often saw her brother-in-law, who is a cardiologist.

This “highlights the importance of hospital- and physician-related contacts in history taking,” the researchers said. Other factors that should be considered when taking a history include recent antimicrobial therapy and previous MRSA colonization, they said.

However, all patients had little to no scarring after the infection and wound had healed.

These surgical site infection rates were similar to those of the only previous study looking at rates after facelift (0.18% vs. 0.3% for hospitalization).

Although all four MSRA-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).

The reason for the high rate of MRSA infections compared to other pathogens may include the aggressive nature of MRSA and the use of postoperative antibiotics effective against methicillin-susceptible S. aureus, Dr. Zumalan and Rosenberg said.

“With MRSA colonization and infections on the rise,” they said, “facial plastic surgeons performing rhytidectomy and other soft tissue procedures may want to consider introducing screening protocols to identify patients at increased risk of infection.”