Ioana Berciu

Microbiologic Safety of the Transareolar Approach in Breast Augmentation

BACKGROUND In aesthetic breast augmentation, especially by the transareolar approach, there is increasing concern regarding the occurrence of capsular contracture and its potential correlation with intraoperative implant contamination from putative endogenous breast flora of the nipple and lactiferous ducts. However, detectable bacteria cannot be considered synonymous with established resident microflora. OBJECTIVES The authors sought to elucidate the existence of endogenous breast flora and assess the microbiologic safety of transareolar breast augmentation. METHODS In this prospective study (BREAST-MF), the authors collected microbiologic samples from the breast skin, ductal tissue, and parenchyma of 39 consecutive female patients who underwent breast procedures in a plastic surgery clinic. Swabs collected pre-, intra-, and postoperatively were processed for bacterial and fungal growth. Positive cultures underwent identification through VITEK and MALDI-TOF, as well as antimicrobial susceptibility testing. RESULTS Staphylococcus species accounted for 95 of 106 (89.6%) positive results from native breast skin, 15 of 18 (83.3%) positive results from decontaminated breast skin, and 4 of 4 (100%) positive results from the breast parenchyma. Methicillin resistance was present in 26.4% of S. epidermidis, 25.3% of S. hominis, and 71.4% of S. haemolyticus strains. CONCLUSIONS During transareolar breast augmentation, in the nipple-areola region it is more likely to find bacteria populating the skin, rather than endogenous breast flora, as previously considered. Appropriate preoperative decontamination is essential for minimizing the risk of postoperative infections. LEVEL OF EVIDENCE 3: Risk.

BReast Ecology Assessment in the STudy of local MicroFlora - Study Protocol

INTRODUCTION Recent articles have described an endogenous breast flora, particularly in the nipple ducts, with potential implications in the outcome of aesthetic breast surgery. To characterize the ecology of the breast, we designed a study to assess the microbial species identified on the breast skin and parenchyma in patients undergoing breast surgical interventions. METHODS AFTER OBTAINING INFORMED CONSENT AND BACKGROUND DATA ON CONCURRENT DISEASES, PREVIOUS CONTACT WITH THE HOSPITAL SYSTEM AND PRIOR USE OF ANTIBIOTICS, SAMPLES ARE COLLECTED PREOPERATIVELY FROM THREE AREAS OF THE BREAST SKIN, BILATERALLY: the inframammary fold, the areola and the axilla, prior to decontamination. These samples will serve as positive controls and will aid in characterizing the normal breast skin flora. After preoperative decontamination, samples are again collected, to check for any residual bacterial flora and the nipple is sealed with Tegaderm (3M, USA) and betadine ointment, to reduce any putative bacterial load. Intraoperatively, samples are collected from: a) the incision line (dermal level): 1. superficially, 2. medium depth in the breast parenchyma, 3. deep parenchyma, and b) axillary parenchyma (where possible), together with a bioptic fragment. Postoperatively, a second nipple sample is collected. For secondary breast augmentation surgeries, capsular biopsy is also performed (where relevant), and the implants undergo sonication, to allow biofilm identification. In the laboratory, all samples are cultured on blood agar incubated with CO2, cystine lactose electrolyte deficient medium and Sabouraud gentamicin-chloramphenicol agar. For positive culture samples, the number of colonies and their morphologic characteristics are reported. Identification will be carried out with MALDI-TOF and VITEK (bioMérieux, France), yielding automated antibiotic sensitivity profiles. For all germs with sensitivity profiles differing from the wild-type strain, E-tests will be performed. Follow-up information on the postoperative evolution will be collected and analyzed for potential factors predictive of good evolution. DISCUSSION This study will provide important information about the microflora of the breast skin, its sensitivity profile, and the degree of contamination of the nipple ducts and parenchyma, if any, addressing a scientific hypothesis insufficiently explored so far.

Nasopharyngeal bacterial colonization in children – study hypothesis

Background With monthly reports of decreased bacterial susceptibility to antibiotics and the soaring incidence of invasive infections, it becomes increasingly important to assess bacterial colonization, as this can easily constitute a reservoir for infection. Entering the community for kindergarten and school training is an important step for children, particularly since this may be associated with a change in the microbiota.

Resistance profile of Staphylococcus aureus strains isolated from patients treated in a tertiary care hospital in Romania

Results We examined 149 strains of S. aureus, 44.9% from cutaneous wound infections, 31.2% from blood cultures, 8.4% from sputum samples and 15.3% from other infection sites. Of the total number of strains identified, 55.7% were resistant to methicillin, 35.1% were resistant to clindamycin (D-test results are presented separately), 30.9% were resistant to levofloxacin, 18.7% were resistant to rifampin and smaller percentages were identified for resistance to other drugs. Surprisingly, resistance was also identified to drugs that are not used in clinical practice in Romania, such as daptomycin (6.8%) or fusidic acid (4.8%), suggesting a possible international circulation of S. aureus strains, probably through means of nasal or axillary carriage. We excluded a mechanism of daptomycin non-susceptibility through thickened bacterial cell walls in strains of vancomycin-intermediate S. aureus, as all strains were susceptible to vancomycin.

Nasopharyngeal microbiota evaluation in three cohorts of children in the Romanian pediatric population

Methods We performed a screening study for nasopharyngeal carriage of Staphylococcus spp. in immunocompetent children aged 7-10 years old, attending a community school in central Bucharest (group 1), and in two groups of immunosuppressed children: children with hemato-oncologic diseases (lymphoma/leukemia) admitted to the Fundeni Clinical Institute, Bucharest (ages 2-10 years, group 2), and institutionalized children with vertically transmitted HIV infection, from the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest (ages 1-10 years, group 3).

Assessment of bacteriophage activity against local strains of Enterococcus and Pseudomonas in Romania.

Methods In this study we used a bacteriophage testing kit containing 4 types of Georgian products: PYO, INTESTI (Eliava BioPreparations, Tbilisi) and PHAGYO, PHAGESTI (JSC “Biochimpharm”, Tbilisi) to test the strains of Pseudomonas spp. and Enterococcus spp. isolated and stored from patients treated in the Adults II ward of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Romania during April 2013 – July 2014.

Dual infection with Acinetobacter baumannii and Klebsiella pneumoniae in a patient with multiple comorbidities – case presentation

Case report A 35 year-old male patient presented to our clinic in May 2014 for progressive malaise, low-grade fever and nausea. His medical history revealed chronic glomerulonephritis and renal failure with hemodialysis from 2005 to 2010; kidney transplant in 2010, with transplant rejection and positive CMV-IgM in March 2014. He also presented arterial hypertension, ischemic heart disease and left ventricular hypertrophy since 2010, multiple episodes of sepsis and pneumonia with Klebsiella spp. through digestive microbial translocation (colonic ulcerations), and a double aortocoronary bypass in March 2014. The thoracotomy incision had healed almost completely, but the right calf incision presented signs of infection. His concomitant therapy included anti-hypertensive agents, antiplatelet therapy, ganciclovir, immune-suppression therapy with mycophenolic acid, and prednisone (10 mg/day). On admission, the clinical exam was normal, except for bilateral lower limb edema and inflammation of the right calf incision area, with multiple patches of exposed soft tissue and suppuration. Biologically, he presented pancytopenia (WBC 2,100 cells/μL, hemoglobin 6.8 g/dL, thrombocytes 137,000 cells/μL), nitrogen retention syndrome (urea 147.4 mg/dL, creatinine 4.4 mg/dL). The patient’s reactivity was quite low given the concomitant immune-suppressive treatment, with ESR 38 mm/1h, fibrinogen 351 mg/dL, and CRP 10 mg/L. Urine cultures, repeated blood cultures and procalcitonin were negative, but the smear from the right calf incision wound identified inflammatory cells and Gramnegative coccobacilli, and CLED cultures grew smooth, yellow, lactose-fermenting colonies. Microscan (Siemens, Munich, Germany) identified carbapenemase-producing Klebsiella pneumoniae (KPC) and the strain was subcultured and grew a smooth, grey, non-lactose-fermenting colony, identified on VITEK (bioMerieux, Paris, France) as Acinetobacter baumannii. Both strains were resistant to all tested drugs except for colistin and tigecycline. As both strains initially grew in a single isolated culture, with homogenous morphology, it took repeated cultures to separate the two strains. The patient’s evolution was favorable under treatment with tigecycline and local instillations of colistin.

Serum inhibitory and bactericidal titers in the clinical management of bacterial infections

Background The clinical management of bacterial infection computes factors related to bacteria (e.g., resistance profile [1]), antibiotics (e.g., activity spectrum, distribution volume, etc.), host characteristics (e.g., vascularization of the infected tissue, effectiveness of host defenses, etc.), as well as pharmacokinetic (PK) parameters [2]. The serum inhibitory (SIT) and bactericidal titers (SBT) are laboratory tests that simulate the interactions between antibiotics and bacteria in the human body milieu.

Recurrent infective endocarditis due to probable biofilm formation on cardiac stimulator probe

Background The global increase in antibiotic resistance and the high number of implant-associated infections have rendered antibiotics ineffective in certain cases. So it’s time for a new therapy. Bacteriophages are obligatory intracellular parasites of bacterial cells and bacteria can be infected by bacteriophages. They have specificity of infection, due to the presence of specific receptors on the bacterium surface.

Dialysis peritonitis in a patient with chronic kidney disease and multiple comorbidities

Background Patients with peritoneal catheters are at risk for developing infections with germs with altered antibiotic sensitivity, being classified as Carmeli 3 due to repeated invasive contact with the hospital system. A cloudy peritoneal fluid is oftentimes a sentinel sign of infection and medical and surgical management are generally required to clear infection and prevent subsequent reoccurrences.