First Identification of a Patient with Prosthesis-Related Infection Caused by an MCR-1.1-Producing ST131 Escherichia coli After Rhinoplasty

Complications and Treatments of Pseudomonas aeruginosa Infection After Rhinoplasty With Implants: A Clinical Study

BACKGROUND

Pseudomonas aeruginosa is an opportunistic pathogen, and because of its specificity, its treatments appear tricky in postrhinoplasty infections with internal implants. This study summarizes the clinical characteristics and treatment of this type of infections to provide some reference for clinical work.

METHODS

We retrospectively analyzed 10 patients who were diagnosed with a nasal infection of P. aeruginosa after implant nasal augmentation. The results of the bacterial culture and drug sensitivity test of the patients' wound secretions were summarized and analyzed. We summarized the characteristics of the patients' infection and the treatments, and we also summarized the patients' prognosis.

RESULTS

In these 10 cases, their implants included rib cartilage and ear cartilage alone, as well as their own cartilage combined with expanded polytetrafluoroethylene and silicone. All patients developed wound infections within 1 month after rhinoplasty, with bacterial cultures of P. aeruginosa . Prolonged use of sensitive antibiotics, as well as wound dressing changes, failed to keep the infection well under control. Patients whose implant was removed and thoroughly debrided within 1 week of infection did not experience any serious complications. In patients who were infected for >1 week before surgery to remove the implants, complications such as nasal column necrosis and nasal contracture occurred, and later the nasal repair was performed after multiple surgeries.

CONCLUSIONS

For bacterial infections in postrhinoplasty wounds with implants, we recommend early bacterial culture. If the infection is clearly P. aeruginosa , the implant should be removed and thoroughly debrided as soon as possible to avoid serious complications.

LEVEL OF EVIDENCE

Level IV.

Evaluation of Clinical Outcomes and Satisfaction of Rhinoplasty with or without Smasectomy with the Aim of Thinning the Nasal Tip in Patients with Thick Nasal Skin

Background:

Rhinoplasty is one of the most common plastic surgeries and a challenging procedure for people with thick nasal skin. There are several techniques to improve the outcome of the operation.

Methods:

Our study is a double-blind randomized controlled trial conducted in Esfahan, Iran in 2020. Seventy participants were equally divided into two groups (35 people). In the control group, only rhinoplasty was performed without SMASectomy and in the intervention group, rhinoplasty was performed with SMASectomy. The results were obtained and the satisfaction of patients and physicians was collected through patient examination and a questionnaire. Statistical analysis of data was calculated by SPSS software version 23 at a significance level of less than 0.05.

Results:

The mean total skin thickness before surgery in the two groups was equally, which showed a significant difference between the two groups at after 12 months (P <0.05). Comparison of 3, 6 and 12 months after rhinoplasty in the two groups showed that the percentage of patient, doctor, hairdresser and nurse satisfaction, in 12 months after rhinoplasty, in the intervention group compared to the control group had a significant increase (P <0.05). Furthermore, in the control group 2.85% and in the intervention group 5.71% bleeding was observed. No other complications were observed in any of the groups.

Conclusion:

Overall, SMASectomy, which is performed simultaneously with rhinoplasty, is considered as an important technique in rhinoplasty. As we observed in our study, the complications of these surgeries in patients were very small.

Colistin-Resistant mcr-1-Positive Escherichia coli ST131-H22 Carrying bla CTX-M-15 and qnrB19 in Agricultural Soil

The pandemic Escherichia coli sequence type 131 (ST131) carrying plasmid-mediated colistin resistance mcr genes has emerged worldwide causing extraintestinal infections, with lineages belonging to three major clades (A, B, and C). Clade B is the most prevalent in animals, contaminating associated meat products, and can be transmitted zoonotically. However, the bla_CTX–M–15 gene has only been associated with C2 subclade so far. In this study, we performed a genomic investigation of an E. coli (strain S802) isolated from a kale crop in Brazil, which exhibited a multidrug-resistant (MDR) profile to clinically significant antimicrobials (i.e., polymyxin, broad-spectrum cephalosporins, aminoglycosides, and fluoroquinolones). Whole-genome sequencing analysis revealed that the S802 strain belonged to serotype O25:H4, ST131/CC131, phylogenetic group B2, and virotype D5. Furthermore, S802 carried the clade B-associated fimH22 allele, genes encoding resistance to clinically important antimicrobials, metals, and biocides, and was phylogenetically related to human, avian, and swine ST131-H22 strains. Additionally, IncHI2-IncQ1, IncF [F2:A-:B1], and ColE1-like plasmids were identified harboring mcr-1.1, bla_CTX–M–15, and qnrB19, respectively. The emergence of the E. coli ST131-H22 sublineage carrying mcr-1.1, bla_CTX–M–15, and qnrB19 in agricultural soil represents a threat to food and environmental safety. Therefore, a One Health approach to genomic surveillance studies is required to effectively detect and limit the spread of antimicrobial-resistant bacteria and their resistance genes.