TY - JOUR

T1 - Bacterial biofilm formation and treatment in soft tissue fillers

AU - Alhede, Morten

AU - Er, Ozge

AU - Eickhardt, Steffen

AU - Kragh, Kasper

AU - Alhede, Maria

AU - Hultqvist, Louise Dahl

AU - Poulsen, Steen Seier

AU - Givskov, Michael

AU - Christensen, Lise H

AU - Høiby, Niels

AU - Tvede, Michael

AU - Bjarnsholt, Thomas

N1 - This article is protected by copyright. All rights reserved.

PY - 2014/1/30

Y1 - 2014/1/30

N2 - Injection of soft tissue fillers plays an important role in facial reconstruction and aesthetic 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 succesive 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 This article is protected by copyright. All rights reserved.

AB - Injection of soft tissue fillers plays an important role in facial reconstruction and aesthetic 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 succesive 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 This article is protected by copyright. All rights reserved.

U2 - 10.1111/2049-632X.12139

DO - 10.1111/2049-632X.12139

M3 - Journal article

C2 - 24482426

VL - 70

SP - 339

EP - 346

JO - FEMS Immunology and Medical Microbiology

JF - FEMS Immunology and Medical Microbiology

SN - 2049-632X

ER -