Tissue expander with acellular dermal matrix for breast reconstruction infected by an unusual pathogen: Candida parapsilosis.
Infections occur in approximately 2-5% percent of women undergoing breast reconstruction by tissue expansion depending on patient characteristics and timing of reconstruction. Bacteria, specifically Staphylococci, are the most common pathogens. Treatment varies depending on the surgeon and the aggressiveness of the infection. We report a case of unilateral tissue expander infection with Candida parapsilosis in an otherwise healthy female undergoing immediate tissue expander placement after bilateral nipple-sparing mastectomies. The patient was treated with a one-stage irrigation, debridement, and tissue expander exchange as well as a 21-day course of oral antifungal therapy. Her infection resolved and she was able to complete her implant-based reconstruction. C. parapsilosis is usually responsible for infections in critically ill patients found in association with central lines, peritoneal dialysis catheters and prosthetic heart valves. The affinity of C. parapsilosis for foreign material makes it a causative agent worth considering in difficult to treat tissue expander infections.
Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA, United States.
Paige M
PM
Fox
Gordon K
GK
Lee
D062088:Acellular Dermis / Q000009:adverse effects*; D000935:Antifungal Agents / Q000627:therapeutic use; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D002175:Candida / Q000145:classification*; D002177:Candidiasis / Q000209:etiology* / Q000628:therapy; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D015414:Mastectomy, Subcutaneous / Q000379:methods; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000628:therapy; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D007507:Therapeutic Irrigation / Q000379:methods; D015625:Tissue Expansion Devices / Q000009:adverse effects*; D014945:Wound Healing / Q000502:physiology
D000935:Antifungal Agents