Invasive Group A Streptococcus infections linked to outpatient liposuction done in medica; spas in US
TUMESCENT liposuction is a popular cosmetic procedure done as an out-patient in many medical facilities, including medical spas.
In 2012, an outbreak was reported which involved 13 patients developing severe surgical site infection following the procedure which was done in medical spas in the United States. Of the 13 post-liposuction clients who developed infection, one died.
Beaudoin AL et al. reported in the July issue of the Journal of the American Medical Association (JAMA) the results of their investigation on the 2012 outbreak. They concluded that invasive group A Streptococcus infections was associated with the liposuction surgery done at outpatient facilities not subject to state or federal regulation. (JAMA Intern Med 2014 Jul; 174:1136)
Group A Streptococcus (GAS) has always been feared by surgeons as a cause of surgicalsite infections, which could lead to potentially fatal complications such as toxic shock syndrome and necrotizing fasciitis. Cosmetic surgeons have been wary about this complication, especially for procedures done in the outpatient setting in facilities wherein the anti-infection precautionary measures may not be that stringent.
In this JAMA report, researchers reported that of the 13 cases of GAS infection, four have been confirmed, while nine was suspected. The 13 were among 66 patients who had undergone liposuction procedures at either of two affiliated outpatient surgery facilities between July 1 and September 14, 2012. This gives a highly alarming infection rate of 20 percent.
Of the four patients with confirmed invasive GAS infections who developed necrotizing fasciitis, three had clinical signs and symptoms of possible toxic shock syndrome. Of these four, one died. It has been noted by healthcare workers that surgeons usually make a routine prescription of cephalexin or azithromycin for their patients undergoing liposuction.
Based on their investigation, all procedures which developed GAS infection were done by a single surgical team, two of which were found to be colonized with GAS. Based on the investigation, genotypes of their isolates and the isolates available for molecular typing from patients with confirmed infection were shown to be identical.
The investigators also discovered multiple deficiencies in infection-control practices in the two facilities; and neither the facilities nor the procedures conducted were covered by state or federal regulation.
Commenting on this report in Journal Watch General Medicine, Larry M. Baddour, MD said that this is the first reported outbreak of invasive GAS infections associated with liposuction. “It highlights the potential harm to individuals who undergo cosmetic procedures — even seemingly minor ones performed in an outpatient setting without any type of anesthesia. The experience should prompt a renewed interest in establishing minimal infection prevention and control standards in all cosmetic surgery facilities,” he wrote in his commentary. With JAMA and JW reports
VitalSigns Issue 65 Vol. 3, July 1-31, 2014