Bacterial biofilm formation and treatment in soft tissue fillers.
Injection of soft tissue fillers plays an important role in facial reconstruction and esthetic treatments such as cosmetic surgery for lip augmentation and wrinkle smoothening. Adverse events are an increasing problem, and recently, it has been suggested that bacteria are the cause of a vast fraction these. We developed a novel mouse model and evaluated hyaluronic acid gel, calcium hydroxyl apatite microspheres, and polyacrylamide hydrogel for their potential for sustaining bacterial infections and their possible treatments. We were able to culture Pseudomonas aeruginosa, Staphylococcus epidermidis, and Probionibacterium acnes in all three gels. When contaminated gels were left for 7 days in a mouse model, we found sustainment of bacterial infection with the permanent gel, less with the semi-permanent gel, and no growth within the temporary gel. Evaluation of treatment strategies showed that once the bacteria had settled (into biofilms) within the gels, even successive treatments with high concentrations of relevant antibiotics were not effective. Our data substantiate bacteria as a cause of adverse reactions reported when using tissue fillers, and the sustainability of these infections appears to depend on longevity of the gel. Most importantly, the infections are resistant to antibiotics once established but can be prevented using prophylactic antibiotics.
Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology 9301, Rigshospitalet, Copenhagen, Denmark.
Morten
M
Alhede
Özge
Ö
Er
Steffen
S
Eickhardt
Kasper
K
Kragh
Maria
M
Alhede
Louise Dahl
LD
Christensen
Steen Seier
SS
Poulsen
Michael
M
Givskov
Lise H
LH
Christensen
Niels
N
Høiby
Michael
M
Tvede
Thomas
T
Bjarnsholt
D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects*; D018407:Bacterial Physiological Phenomena; D001672:Biocompatible Materials / Q000009:adverse effects*; D018441:Biofilms / Q000187:drug effects* / Q000254:growth & development*; D005260:Female; D020100:Hydrogels; D051379:Mice; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000502:physiology
D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D020100:Hydrogels
biofilm; calcium hydroxyl apatite microspheres; hyaluronic acid gel; polyacrylamide hydrogel; prophylactic treatment; soft tissue fillers