A small, but worrisome number of facelift patients became infected with the antibiotic-resistant staph infection known as MRSA, a new study reports.
About one half of 1 percent of people undergoing facelifts developed the so-called "superbug" methicillin-resistant Staphylococcus aureus infection, doctors from Lennox Hill-Manhattan Eye, Ear, and Throat Hospital in New York City reported.
According to the U.S. Centers for Disease Control and Prevention, S. aureus, commonly found on the skin and in the nose of healthy individuals, is associated with bacterial skin infections. MRSA, as its name implies, is a particularly nasty strain of S. aureus that is resistant to the class of antibiotics that includes penicillin, amoxicillin and methicillin.
Traditionally, MRSA, which can cause boils, skin cell death, and even death, has been limited to hospital settings and crowded environments such as prisons. Yet, beginning in 1999, community-associated cases of the disease have been on the rise. Last year, a study in the Journal of the American Medical Association found that more Americans died of MRSA than of AIDS in 2005.
"The MRSA issue is societal now and is generally recognized as a risk factor for all surgical procedures," said Dr. Jeffrey C. Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine, who was not involved with the new study, published in the March/April issue of the Archives of Facial Plastic Surgery.
Salomon's suggestion: "Patients should be screened for a history of prior infections and if indicated, patients can be screened with nasal cultures to see if they are MRSA carriers," he said. "A rising issue in cosmetic surgery has been the increase of atypical mycobacterium infections and should be considered in the differential diagnosis of patients with late onset of infections."
For the new study, Dr. Richard A. Zoumalan and Dr. David B. Rosenberg looked at the medical records of 780 patients who had facelifts at one outpatient surgical center between 2001 and 2007. They found that five patients developed infections at the surgical site, and four of them (0.5 percent of all patients) tested positive for MRSA.
Two of the patients who tested positive for MRSA were admitted to a hospital for antibiotic therapy. Both of them may have been exposed to MRSA before their facelifts. One patient had spent time with her husband, who had been in a cardiac intensive-care unit four months earlier; the other had contact with her brother-in-law, a cardiologist, the study authors noted.
Salomon said that because the rate of infection after facelift surgery is extremely low, some doctors may be less vigilant in creating a sterile environment for the procedure.
"Historically, the incidence of infection after facelift is extraordinarily low, even without pre-operative shampoos or peri-operative antibiotics," Salomon said. "Facelift surgery has been one of the most casual operations in terms of attention to creating a sterile field simply because the incidence of infection is so low."
Other risk factors for MRSA infection include having taken antibiotics or having been hospitalized recently, contact with health-care workers, previous MRSA infection, older age, diabetes, smoking and obesity, the study authors said.
"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," Zoumalan and Rosenberg wrote. "During preoperative evaluation, a full medical history should include information on possible prior contacts with persons at high risk for carrying MRSA."
More information
To learn more about MRSA, visit the U.S. Centers for Disease Control and Prevention.