Late Subcutaneous Infection Caused by Serratia marcescens Following Hyaluronic Acid Injection: A Case Report and Systemic Review.

BACKGROUND

The field of cosmetic filler injection has experienced rapid development over the past two decades, especially in facial augmentation utilizing hyaluronic acid (HA) fillers. Gram-negative bacteria are found to be the main pathogens of infective nodules after HA injection. The occurrence of cutaneous infections attributed to Serratia marcescens is exceedingly rare and predominantly noted in patients with compromised immune systems.

AIMS

To summarize the clinical features, diagnosis, and treatment of subcutaneous infection caused by Serratia marcescens following hyaluronic acid injection.

PATIENTS/METHODS: A rare case of cutaneous Serratia marcescens infection following hyaluronic acid injection was presented. A comprehensive review of the published literature describing the management of skin infection caused by S. marcescens in immunocompetent patients was then conducted, which encompassed three case series and eight case reports published between 1999 and 2017. Data extraction included information on authors, gender, age, signs and symptoms, previous treatment, corresponding management strategies, and follow-up duration.

RESULTS

Serratia marcescens were isolated in abscesses (n = 6, 35.29%), painful nodules (n = 2, 11.76%), ulcers (n = 6, 35.29%), and others (n = 3, 17.65%). In cases providing salvage plans (n = 11), quinolones were shown to be the most effective antibiotics for salvage, with eight full recoveries (72.73%), and trimethoprim-sulfamethoxazole was the second most useful antibiotic (18.18%).

CONCLUSIONS

With the help of pathogen examination and drug-sensitive tests, sensitive aminoglycosides, quinolone (especially moxifloxacin), or TMP-SMX for at least 2 weeks can be considered as the first-line treatment of late subcutaneous infection caused by Serratia marcescens following hyaluronic acid injection.