Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes

Etiology, Microbiological Isolates, and Antibiotic Susceptibilities in Inpatients with Refractory Auricular Perichondritis: A 10-Year Retrospective Study

Purpose

This study aimed to elucidate the etiologies, microbiological profiles, antibiotic susceptibilities of bacteria and outcomes of patients with auricular perichondritis.

Patients and Methods

This was a single-center retrospective study. Inpatients diagnosed with auricular perichondritis at a university teaching hospital in eastern China between January 2013 and December 2022 were included in this study.

Results

A total of 127 patients were enrolled, with an average age of 50.6 ± 16.9 years. In addition to cases in which the etiology remained undetermined in 37% of the patients, postoperative infection emerged as the predominant cause (37.8%), followed by trauma (18.1%). Among the 61 cultured isolates, 21.3% were gram-positive bacteria, 55.7% were gram-negative bacteria, and 23.0% were fungal isolates. The most frequent isolate was Pseudomonas aeruginosa (30/61, 49.2%). Notably, the incidence of fungal infections was markedly higher among postoperative patients than among post-traumatic patients (41.7% vs 7.1%, p = 0.03). The proportions of gram-negative bacteria (60.0% vs 50.0%) and fungal isolates (28.6% vs 15.4%) exhibited an increasing trend during the period of 2018-2022, as compared to the previous period of 2013-2017. The bacterial isolates exhibited high susceptibility to vancomycin (100%), amikacin (100%), cefepime (94.6%), and ceftazidime (90.9%). In contrast, overall susceptibility to fluoroquinolones was relatively low (65.2-67.4%), demonstrating a declining trend in the susceptibility of Pseudomonas aeruginosa. Notably, 78.7% of the patients received an initial treatment regimen covering Pseudomonas aeruginosa. Within 30 days of discharge, 8.5% (6/71) experienced an infection recurrence.

Conclusion

Auricular perichondritis predominantly originates from iatrogenic (postoperative) infections. Antibiotic therapy covering Pseudomonas aeruginosa is a sensible and appropriate empirical treatment in the majority of patients with auricular perichondritis. However, increased resistance to fluoroquinolones has become a notable concern, suggesting the need to seek new, more aggressive strategies.

The incidence of vasovagal reactions during earlobe piercing

Background

Vasovagal reactions are common amongst patients with a fear of needles receiving injections or during venipuncture, but they are rarely studied in healthy people undergoing earlobe piercing. The purpose of this prospective study was to evaluate the incidence and the features of vasovagal reactions observed during earlobe piercing.

Methods

Thousand eight hundred and sixty six participants aged older than 13 years had their earlobes pierced in our department from January 2020 to January 2022. When vasovagal reactions occurred during the procedure (e.g., dizziness, pallor, diaphoresis, and faintness, etc.), they were recorded and more detailed demographic information was collected.

Results

A total of 196 cases of vasovagal reactions were reported in females amongst 1,866 participants, including 58 who actually lost consciousness during earlobe piercing. The incidence of vasovagal reactions and vasovagal syncope was 10.5 and 3.11% respectively. All syncopal reactions occurred in persons younger than 30 years.

Conclusion

Vasovagal syncope is often very sudden and occurs without warning. Practitioners need to be familiar with these reactions, and prevent people from an unpredictable fall and subsequent injury during ear piercing.

A Study of Body Modification Artists’ Knowledge, Attitudes, and Practices Toward Infection Control: A Questionnaire-Based Cross-Sectional Study

Background

Tattoos and piercings, which were once considered taboo, are now widespread like an epidemic, among people of all ages and gender. The rising demand for such body alterations has given rise to a large number of infective complications. This study was, therefore, designed to assess the infection control knowledge, attitudes, and practices of body modification artists in Ethiopia, 2021.

Methods

An anonymous observational cross-sectional study was conducted in Addis Ababa, Ethiopia, from May 25 to June 22, 2021. The data collection instrument was a structured questionnaire that covered the participants’ socio-demographic characteristics, knowledge, attitudes, and practices related to infection control. On the whole, 172 tattoo and body piercing artists participated in the study. SPSS v.20 software was used for data entry and analysis. Pearson’s correlation test, t-test, Tukey’s test, and multiple linear regression analysis were conducted during the data analysis.

Results

Male participants constituted well over three-fourths (96.5%, n = 166) of the sample considered in the study. According to the result, the participants’ knowledge of infection control received the lowest score (7.1 ± 1.22). Participants’ scores of knowledge of infection control increased with an increase in their experience in the multiple linear regression. Experience and training time were also associated with knowledge. Infection control practice was positively associated with the respondents’ attitudes. After controlling other variables, it was found that a one-unit increase in respondents’ attitude scores increased their practice level by 86%.

Conclusion

This is the first study in Ethiopia to examine tattooists’ and body piercers’ infection control knowledge, attitude, and practice. Minimum standards for infection control in inking and piercing establishments are necessary. It is therefore important that local authorities and public health professionals work towards laying down the minimum code of practice for infection control in inking and piercing establishments.

Bacterial infections in patients with nipple piercings: a qualitative systematic review of case reports and case series

The main objective of this review is to identify the most frequently isolated bacteria in patients with infections related to nipple piercings in case reports and case series. In addition, the aim is to describe clinical manifestations and antecedents. There is a protocol of this review. The terms "bacterial infections", "nipple piercing" and their synonyms were considered. Pubmed/Medline, Scopus, Embase, Web of Science core collection and Ovid/Medline databases were searched until November 15, 2021 without date or language restrictions. Two authors extracted the articles and three other authors performed the selection, first by title and abstract, and second by full-text revision. Discrepancies were resolved with yet two other authors. Quality was assessed using the Joanna Briggs checklists. Finally, data extraction was realized. A total of 1,531 articles were extracted, of which 20 articles were included, and one article was added by hand-searching. The final number of articles included was 21, all of them with acceptable quality of evidence. Twenty-seven patients were considered (23 women and 4 men), aged between 15-60 years old. The most frequent bacterial genus in case reports and case series was Staphylococcus (n=10), and the most frequent species was M. fortuitum (n=6), although etiology seems to be diverse. The breast was the main affected organ, and the most frequent findings were fluid collection, pain, erythema, granulation tissue and swelling. The suspicion of infection by this bacterial species could be taken into account when it is associated with nipple piercings; however, larger studies are required to give a conclusion based on the evidence.

Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty: A case report and literature review

Endoscope is an innovative method for otologists in middle ear surgery. Many previous studies have confirmed the safety and efficiency of the endoscopic technique, as a reliable therapeutic option with very low complication rates, clearly supporting the use of endoscopy in ear surgery. Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty is an extremely rare type of those without any previously reported cases. In this report, we describe the course of auricular suppurative perichondritis of a 55-year-old woman. The patient was ultimately healed through surgical debridement and postoperative dressing with no evidence of recurrence at two months follow-up. There were no auricle deformity or external auditory canal stenosis with six months following-up.

Development of 3D Printed Drug-Eluting Scaffolds for Preventing Piercing Infection

Herein, novel drug-eluting, bio-absorbable scaffold intended to cover piercing studs is introduced. This “biopierce” will stay in human tissue following piercing, and will slowly release an antimicrobial agent to prevent infection while the wound heals. Nearly 20% of all piercings lead to local infection. Therefore, it is imperative to develop alternative methods of piercing aftercare to prevent infection. Biopierces were made using mupirocin loaded poly-lactic-co-glycolic acid (PLGA) biomaterial ink, and a low-temperature 3D printing technique was used to fabricate the biopierces. Proton nuclear magnetic resonance (¹H NMR) spectroscopy was used to confirm the complete removal of the solvent, and liquid chromatography high-resolution mass spectrometry (LC-HRMS) was used to confirm the structural integrity of mupirocin and to quantify the amount of the released drug over time. The efficacy of the biopierces against Staphylococcus aureus, one of the most common piercing-site pathogens, was confirmed over two weeks using in vitro antimicrobial susceptibility testing.

Health Implications and Counseling Considerations for Individuals With Piercings and Tattoos

Body art has become common and mainstream. Tattoos and body piercings represent highly individual expressions of identity and personal values. Health care services are enhanced when clinicians understand the anatomy and physiology, common discomforts, and real but rare serious risks of body modification and are prepared to provide compassionate support for individuals' choices. Special consideration must be given to the needs of childbearing women. By opening channels of communication, clinicians can engage with clients in shared decision making to help those who possess or desire body art take steps to reduce the risk of adverse effects and obtain prompt and effective medical care when problems arise. Through respectful discussion of existing body art, the therapeutic relationship is strengthened, and greater insight into an individual's health needs may be achieved.

Calculated parenteral initial treatment of bacterial infections: Infections in the ear, nose, throat and mouth and jaw area

This is the sixth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter deals with the antibacterial treatment of more severe infections of the ear, the nose, the throat and the maxillofacial region, including odontogenic and salivary gland infections.

[Complications of cosmetic piercings and tattoos in the head and neck region]

Piercings and tattoos have gained popularity across all cultural environments during the past century, and one in ten Europeans are now pierced. While tattoos are often restricted to the rest of the body, piercings are common at facial sites such as ears, nose, lips, and tongue. Complications following piercings are not uncommon. Infections can rapidly spread across the auricular cartilage and require antibiotic and often surgical treatment. Mild trauma (i.e., piercing the earlobe) can lead to excessive scar formation due to fibroblast proliferation. Keloids have a particularly high rate of recurrence and are therefore difficult to treat. Due to recent developments in the field of permanent makeup, tattooing techniques are also increasingly applied in the head and neck region. Here, complications such as infection or allergic reactions can occur. Topical medication or laser procedures are the usual therapeutic options.

Perichondritis of the auricle: bacterial findings and clinical evaluation of different antibiotic regimens

PURPOSE

Pseudomonas aeruginosa is commonly found in suppurative perichondritis, but the significant pathogens in non-abscess perichondritis are unclarified. We aimed to explore the bacterial findings and evaluate the effectiveness of different antibiotic regimes in the treatment of patients with perichondritis.

METHODS

All patients treated for perichondritis at the two Ear-Nose-Throat Departments in Central Denmark Region (covering 20% of the Danish population) from January 1990 to October 2018 were included.

RESULTS

In total, 112 patients with (n = 12) or without (n = 100) abscess were included in the study. Potential pathogens were found in 40 of 55 cultures. P. aeruginosa was recovered in 58% of abscess cases, while Staphylococcus aureus was predominant in non-abscess infections (49%). Eighty-two percent of S. aureus recovered were isolated as heavy or moderate growth. In non-abscess cases, no significant differences in clinical progress (p = 0.65), alteration in antibiotic therapy (p = 0.31), duration of hospitalization (p = 0.65), or frequency of relapse of infection (p = 1.00) or sequelae (p = 0.38) were found between patients treated with antibiotics covering S. aureus vs. P. aeruginosa.

CONCLUSIONS

Our findings suggest that intravenous antibiotic therapy covering S. aureus is sufficient and appropriate empirical treatment in the majority of patients with non-abscess perichondritis. Antibiotic coverage should be expanded to include P. aeruginosa if the clinical response is disappointing or cultures grow P. aeruginosa. The risks and downsides to this approach seems limited as only a minority of patients suffered (minor) cosmetic sequelae and relapse of infection in our cohort of non-abscess perichondritis patients initially treated with antibiotics not covering P. aeruginosa.

Cross-contamination of bacteria-colonized pierced earring holes and fingers in nurses is a potential source of health care-associated infections

BACKGROUND

In recent years, the wearing of pierced earrings for personal adornment has increased among health care workers in Japan. However, the transmission dynamics between bacteria in pierced earring holes and fingers has not been clearly shown.

METHODS

Earlobes and fingers of 200 nurses (128 nurses with pierced earlobes and 72 nurses with unpierced earlobes) working at a university hospital were sampled to determine whether cross-transmission of bacteria-colonized pierced earring holes and fingers in nurse is possible.

RESULTS

Of 128 nurses who had pierced earring holes, Staphylococcus aureus was recovered from earlobes of 24 nurses (18.8%) compared with 7 of 72 nurses without pierced earring holes (9.7%) (P = .09). Of those 15 nurses yielding S aureus from both earlobes and fingers, 12 were from nurses who had pierced earring holes compared with 3 nurses without pierced earring holes. Excluding 1 nurse, antimicrobial susceptibility patterns and genotypes of S aureus from both earlobe and fingers of each nurse were identical.

CONCLUSION

Pierced earlobes can be a source of health care-associated infection via cross-transmission of bacteria from earlobe holes to fingers.

[Pseudomonas aeruginosa in post-piercing perichondritis: Two case reports]

The frequency of body piercing has increased in France over the past few years, particularly among teenagers. Piercing can be performed at different sites on the body, especially in the cartilage of the ears. We relate two cases of Pseudomonas aeruginosa chondritis. A 10-year retrospective study at the Marseille University Hospital found no additional pediatric cases. These infectious complications can sometimes be necrotizing. It is therefore important to inform the medical staff on the hygiene measures that need to be respected and the patients on the treatment to follow after the piercing as well as the signs to watch for, possibly indicating chondritis. The esthetic consequences depend on early diagnosis.

Body Piercing: Motivations and Implications for Health

Body piercing has evolved from a behavior once considered extreme to an accepted choice among the general population. Earlobe piercing is so common that it is now considered a normative behavior. The motivations for choosing body piercing have changed and are associated with piercing site and number of piercings chosen by the individual. Meanings ascribed to body piercing were traditionally related to enhanced sexual desirability and experience, but now range from the innocuous, such as a fashion statement, to the risk laden, such as nonsuicidal self-injury. Professional piercers are the primary providers of piercing services, and people will first turn to their professional piercer for advice when complications of the site arise, thus delaying entry into needed health care. Health care providers are often perceived as uninformed, dismissive, and biased against individuals, who are pierced particularly those with multiple piercings and piercings in intimate areas of the body. Common complications of piercing include infection, bleeding, and problems relating to tissue trauma and scarring, and are reported by nearly 50% of individuals who are pierced. Metal allergies can develop as a result of piercing, making the type of jewelry used for body adornment an important consideration. Additionally, management of the piercing site becomes critical under certain conditions, such as during pregnancy and birth, lactation, or surgery. This article provides information supporting midwives and other health care providers to offer anticipatory guidance and health care services in a nonjudgmental and supportive manner to individuals choosing body piercing.

Trends and complications of ear piercing among selected Nigerian population

Background:

The reported health and socioeconomic consequences of ear piercing, especially in modern day society, underscore the need to further research into this subject. In this study, we determine the trends and complications of ear piercing among selected Nigerian population.

Aim and Objectives:

The aim and objective of this study was to draw attention to the trends and complications of ear piercing with a view to prevent its associated complications.

Methodology:

It is a descriptive cross-sectional study carried out between February and May 2015 among selected Nigerian population from two of its six geo-political zones. A self-administered semi-structured questionnaire which had been pretested was used to collect data from 458 respondents who consented using multistage sampling technique.

Results:

Of 480 respondents enumerated, 458 completed the questionnaires and gave their biodata. The male:female ratio was 1:6.2. Their ages ranged from 18 to 75 years with a mean of 35.56 ± 10.16. About 35.4% of the respondents were within the age group of 31–40 years. Majority of the respondents, i.e.,79.3% practiced ear piercing on their children. Most of them (86.8%) preferred single piercing. Ear piercing was performed within the 1^st week of birth in 37.2% of the respondents. Large percentage (93.2%) of the respondents will not encourage ear piercing in male children. Nearly 20.5% of the respondents observed complications.

Conclusion:

Ear piercing remained a common practice in Nigeria, with respondents preferring it on females. Majority of the piercings are done in childhood and by untrained personnel. Keloid formation was the notable complication observed by the respondents. There is a need to increase awareness about the hazards of ear piercings and to enact laws that regulate ear piercings particularly in children which is hereby stretched.

Bacterial chondritis complications following ear piercing

BACKGROUND

Body piercing has become widespread and is associated with increased complications. Post-piercing chondritis may lead to severe residual deformity. We aimed to report case patients presenting with post-piercing chondritis in our department and to describe clinical features and treatment.

PATIENTS AND METHODS

We conducted a retrospective study of patients presenting with post-piercing chondritis in the infectious disease department of Tenon Hospital, Paris, France.

RESULTS

We included 21 patients. Fifteen bacteriological cultures were positive (7 Pseudomonas aeruginosa, 5 Staphylococcus aureus, and three other). Dual intravenous antibiotic therapy was administered to 13 patients for a median duration of six days [2-8], replaced by an oral antibiotic therapy for a median duration of 15 days [7-40]. Eight patients received oral antibiotic monotherapy for 10 days [7-30]. Median duration of antibiotic therapy was 16 days. Earring removal was performed for 18 patients. No ear deformity or general complication was reported.

CONCLUSION

Transcartilaginous ear piercing may lead to infectious complications or deformity. In case of chondritis, early administration of an antibiotic therapy active against P. aeruginosa and S. aureus is recommended. Specific guidelines are needed.