Skin bacterial flora as a potential risk factor predisposing to late bacterial infection after cross-linked hyaluronic acid gel augmentation

Irina Netsvyetayeva,1 Wojciech Marusza,2 Romuald Olszanski,3 Kamila Szyller,2 Aneta Krolak-Ulinska,2 Ewa Swoboda-Kopec,1 Janusz Sierdzinski,4 Zachary Szymonski,5 Grazyna Mlynarczyk1 1Department of Microbiology, Medical University of Warsaw, Poland; 2Academy of Face Sculpturing, Warsaw, Poland; 3Military Institute of Health Services, Warsaw, Poland; 4Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland; 5Department of Zoology, Magdalen College, University of Oxford, Oxford, UK Introduction: Cross-linked hyaluronic acid (HA) gel is widely used in esthetic medicine. Late bacterial infection (LBI) is a rare, but severe complication after HA augmentation. The aim of this study was to determine whether patients who underwent the HA injection procedure and developed LBI had qualitatively different bacterial flora on the skin compared to patients who underwent the procedure without any complications. Methods: The study group comprised 10 previously healthy women with recently diagnosed, untreated LBI after HA augmentation. The control group comprised 17 healthy women who had a similar amount of HA injected with no complications. To assess the difference between the two groups, their skin flora was cultured from nasal swabs, both before and after antibiotic treatment in the study group. Results: A significant increase in the incidence of Staphylococcus epidermidis was detected in the control group (P=0.000) compared to the study group. The study group showed a significantly higher incidence of Staphylococcus aureus (P=0.005), Klebsiella pneumoniae (P=0.006), Klebsiella oxytoca (P=0.048), and Staphylococcus haemolyticus (P=0.048) compared to the control group. Conclusion: The bacterial flora on the skin differed in patients with LBI from the control group. The control group’s bacterial skin flora was dominated by S. epidermidis. Patients with LBI had a bacterial skin flora dominated by potentially pathogenic bacteria. Keywords: hyaluronic acid, late bacterial infection, bacterial biofilm, skin bacterial flora, S. epidermidis, S. aureus, Klebsiella spp.