Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London
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A socket full of superbugs: the extrusion of an implant.
Author: Harpreet Kaur
ePoster Number: 256
To describe a case of orbital implant extrusion secondary to indolent methicillin-resistant Staphylococcus aureus (MRSA) infection of the socket.
Clinical and photographic findings are presented, along with management of this case and the results of a literature review of periocular MRSA infections.
A 57 year old lady who had undergone previous right evisceration and MEDPOR implant presented three years post-op with chronic discharge and discomfort. She was found to have a socket granuloma and implant extrusion. There were small amounts of mucoid discharge but no other signs of infection or inflammation. She was systemically well. Pre-op nasopharyngeal swabs showed her to be an MRSA carrier and this was treated as per local guidelines. Subsequent pre-op swabs were MRSA negative. She underwent right implant removal and dermis fat graft but her symptoms were unchanged post-op. The removed implant was sent for microbiological analysis which showed evidence of infection with MRSA. Following discussion with microbiology consultants, she was treated with topical and oral antibiotics. Three weeks following dermis fat graft, she had complete resolution of symptoms and negative MRSA swabs.
This case highlights that infection can be a cause of implant extrusion many years after the initial surgery, not just in the immediate post-op period, even in the absence of obvious signs of infection. It also emphasises the importance of microbiological examination of the removed implant and close working with microbiologists in cases of unexpected findings. This patient had frequent occupational exposure to MRSA but had never had symptomatic infection. A literature review revealed reports of MRSA causing periocular infections such as conjunctivitis and cellulitis, and post-op socket infections following enucleation and exenteration. There were no reports of MRSA infection of the socket causing implant extrusion. It is worth having a low index of suspicion for infection in patients with previous exposure to drug-resistant organisms, even in the absence of overt features of infection.
|First name||Last name||Base Hospital / Institution|
|Sarju||Athwal||Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK|
Abstract ID: 21-154