Marusza Wojciech, Olszanski Romuald, Sierdzinski Janusz, Ostrowski Tomasz, Szyller Kamila, Mlynarczyk Grazyna, Netsvyetayeva Irina
Academy of Face Sculpting, Warsaw, Poland.
Military Institute of Health Services, Warsaw, Poland.
Infect Drug Resist. 2019 Feb 20;12:469-480. doi: 10.2147/IDR.S186996. eCollection 2019.
Late bacterial infections (LBIs) after esthetic facial augmentation using hyaluronic acid (HA) fillers are relatively rare yet severe complications that are difficult to treat. No adequate treatment standards have hitherto been formulated. We have bridged this gap by formulating a treatment scheme based on the principles of treating foreign-body implantation-related infections and treating bacterial growth in the form of biofilm. The objective of this study was to evaluate the efficacy of a comprehensive scheme for treating LBI complications after facial augmentation using cross-linked HA fillers.
A total of 22 patients with LBI symptoms at a site of cross-linked HA injection underwent treatment and observation. The comprehensive treatment scheme formulated by Marusza and Netsvyetayeva (M&N scheme) comprised draining the lesion, dissolution of cross-linked HA with hyaluronidase, broad-spectrum antibiotic combination therapy, and use of probiotics. While 17 patients underwent the M&N scheme, the remaining five were treated with other schemes. Statistical analysis of the data was performed using Mann-Whitney and χ nonparametric tests with SAS 9.4 software.
All 17 patients who underwent the M&N scheme experienced resolution of symptoms, with no recurrence of infection at the HA-injection sites.
To treat LBI at a site of cross-linked HA administration, the principles applicable to infections resulting from implantation of a foreign body must be followed. The treatment period should be sufficiently long for complete resolution of symptoms. The efficacy of treatment is considered proven if 2 months have elapsed without recurrence since the symptoms resolved. The M&N scheme is recommended for use as the first therapeutic option for treating LBI related to soft-tissue fillers.
使用透明质酸（HA）填充剂进行面部美容填充术后的晚期细菌感染（LBIs）相对少见，但却是难以治疗的严重并发症。迄今为止尚未制定出充分的治疗标准。我们基于治疗异物植入相关感染及治疗生物膜形式细菌生长的原则制定了一种治疗方案，填补了这一空白。本研究的目的是评估一种综合方案治疗交联HA填充剂面部填充术后LBI并发症的疗效。
共有22例在交联HA注射部位出现LBI症状的患者接受了治疗与观察。由Marusza和Netsvyetayeva制定的综合治疗方案（M&N方案）包括病灶引流、用透明质酸酶溶解交联HA、广谱抗生素联合治疗以及使用益生菌。17例患者采用M&N方案治疗，其余5例采用其他方案治疗。使用SAS 9.4软件通过Mann-Whitney和χ非参数检验对数据进行统计分析。
所有17例采用M&N方案治疗的患者症状均得到缓解，HA注射部位未出现感染复发。
治疗交联HA给药部位的LBI时，必须遵循适用于异物植入所致感染的原则。治疗期应足够长，以确保症状完全缓解。如果症状缓解后2个月无复发，则认为治疗效果得到证实。推荐将M&N方案作为治疗与软组织填充剂相关LBI的首选治疗方案。
