title: Implant infection after augmentation mammaplasty: a review of the literature and report of a multidrug-resistant Candida albicans infection.
abstract: BACKGROUND
  Implant breast augmentation is one of the most frequently performed surgical procedures, and fungal infection still is considered exceptional. This report presents a case of bilateral breast implant infection by multidrug-resistant Candida albicans treated with a targeted antifungal therapy.
  
  
  METHODS
  A young woman presented with breast pain and asymmetry as well as implant superficialization in the left breast 3 years after bilateral tuberous breast correction with implant insertion. She did not report any trauma to the chest wall or recent systemic infections. The breast was evaluated through mammary compliance analysis and magnetic resonance imaging (MRI).
  
  
  RESULTS
  At surgery, both implants showed capsule contracture and were surrounded by a gelatinous yellow-brown and turbid fluid, which was sent for microbial and fungal analysis. A bilateral capsulectomy was performed. After copious irrigation of the subglandular pockets, submuscular pockets were created, and implants were substituted. Culture swabs tested positive for C. albicans and showed drug resistance to amphotericin B, fluconazole, itraconazole, and voriconazole on the fungal antibiogram. Targeted antifungal therapy with caspofungin was administrated in association with oral antibiotic therapy. Follow-up assessment at 1, 3, 6, 12, and 24 months did not show any infection or contracture relapse.
  
  
  CONCLUSIONS
  This is the first report in the literature on a breast implant infection by a multidrug-resistant C. albicans. The study focused on the association between fungal contamination and capsular contracture and investigated the importance of a fungal antibiogram in cases of suspected prosthesis infection for performance of a targeted antifungal treatment.
authors: Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Rome, Italy. lucadessy@hotmail.com
authors: Luca A
authors: LA
authors: Dessy
authors: Federico
authors: F
authors: Corrias
authors: Francesco
authors: F
authors: Marchetti
authors: Marco
authors: M
authors: Marcasciano
authors: Andrea F
authors: AF
authors: Armenti
authors: Marco
authors: M
authors: Mazzocchi
authors: Bruno
authors: B
authors: Carlesimo
mesh_terms: D001941:Breast Diseases / Q000601:surgery*; D019928:Breast Implantation / Q000009:adverse effects*; D002176:Candida albicans; D002177:Candidiasis / Q000150:complications*; D020878:Device Removal; D026141:Drug Resistance, Multiple, Fungal; D005260:Female; D006801:Humans; D057910:Implant Capsular Contracture / Q000209:etiology / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy*; D012086:Reoperation; D055815:Young Adult