title: Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes.
abstract: OBJECTIVE
  The purpose of this systematic review was to critically analyze infectious complications and treatment following transcartilaginous ear piercing.
  
  
  METHODS
  MEDLINE Pubmed database.
  
  
  METHODS
  A MEDLINE PubMed database search using free text, including "ear chondritis," "ear perichondritis," "ear cartilage piercing," and "auricle piercing," yielded 483 titles. Based on set inclusion and exclusion criteria, the titles, abstracts, and full text articles were reviewed for inclusion and underwent data extraction. Pooled outcomes are reported.
  
  
  RESULTS
  A total of 29 articles met inclusion criteria, including 66 patients. The mean age of the patients was 18.7 ± 7.6 years (range: 11-49), 87.5% female. Ear deformity was more likely to occur following postpiercing perichondritis of the scapha 100% versus the helix 43% (P = 0.003). Mean duration of symptoms prior to patients seeking medical attention was 6.1 ± 4.1 days. Greater than 5 days of symptoms prior to seeking treatment was significantly more likely to result in hospitalization. Pseudomonas aeruginosa accounted for 87.2% infections. Of the patients with Pseudomonas, 92.3% were hospitalized versus 75% of the patients infected with Staphylococcus aureus. Initial oral antibiotics prescribed did not target the cultured bacterium in 53.3% of cases; of these, 87.5% were hospitalized.
  
  
  CONCLUSIONS
  Transcartilaginous postpiercing infection may lead to ear deformity and hospitalization. Patients (customers) and practitioners must be aware of optimal treatment strategies to minimize associated morbidity. Scapha piercing and delay in presentation are associated with poorer outcomes. Pseudomonas is the most common bacterial infection. Initial antibiotic selection must be optimized accordingly.
authors.affiliation: Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, New York.|Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, U.S.A.
authors.forename: Michael
authors.initials: M
authors.lastname: Sosin
authors.affiliation: Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Weissler
authors.affiliation: Georgetown University School of Medicine, Washington, DC, U.S.A.
authors.forename: Marisa
authors.initials: M
authors.lastname: Pulcrano
authors.affiliation: Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
mesh_terms: D046288:Body Piercing / Q000009:adverse effects* / Q000379:methods*; D002357:Cartilage Diseases / Q000209:etiology* / Q000382:microbiology; D004425:Ear Cartilage / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology
keywords: Cartilage; auricle; chondritis; ear; perichondritis; piercing; pinna