Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3181ef9402
Letters

Reply

Nguyen, Alexander T. M.D.; Rohrich, Rod J. M.D.; Fagien, Steven M.D.

Free Access
Article Outline
Collapse Box

Author Information

Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas, Texas (Nguyen, Rohrich)

Boca Raton, Fla. (Fagien)

Correspondence to Dr. Fagien, 660 Glades Road, Suite 210, Boca Raton, Fla. 33431, sfagien@aol.com

Back to Top | Article Outline

Sir:

Figure. No caption a...
Image Tools

We thank Dr. Hassid for his interest in our article and appreciate the comments that highlight the subsequent key advances on this topic. One goal of this article was to further expose the importance of the sessile biofilm over the free-floating planktonic model. The use of injectable soft-tissue filling agents in cosmetic medicine is relatively early in its evolution compared with other aspects of medicine that have experienced issues related to similar tissue reactions to implantable substances, and we are now beginning to understand the relationships and benefit from those before us. We agree that this fundamental understanding highlights why current culture techniques fail to identify biofilm organisms and why pyrosequencing, polymerase chain reaction, fluorescent in situ hybridization, and ultrasound sonication are essential advances that should be considered when biofilms are suspected.

While we await advances in culture techniques to reach mainstream clinical practice, double antibiotic coverage improves the likelihood that patients will receive effective empiric therapy. Here, too, the risks are high with regard to consequences of delayed treatment, and effective treatment, despite an oftentimes educated empiric approach, more often trumps the practical and theoretical risks of promoting antibiotic resistance. Evidence that combination therapy may prevent resistance is limited to tuberculosis and human immunodeficiency virus, diseases synonymous with high resistance, but further research needs to elicit the best antibiotic approach against the resistance provided by biofilms in addition to avoiding the emergence of antimicrobial resistance.1 Once culture yields improve with the newer techniques discussed, antibiotic therapy deescalation should be practiced.

We also agree that alternate or adjunctive approaches should be considered, such as the use of laser-assisted liquefaction and thermal/chemical bioburden reduction procedures, and may offer a promising minimally invasive option that should be investigated further. Once again, we are grateful for Dr. Hassid's comments, which emphasize the next steps in biofilm care.

Alexander T. Nguyen, M.D.

Rod J. Rohrich, M.D.

Department of Plastic Surgery

University of Texas Southwestern Medical Center

Dallas, Texas

Steven Fagien, M.D.

Boca Raton, Fla.

Back to Top | Article Outline

REFERENCE

1. Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–177.

Back to Top | Article Outline
Section Description

GUIDELINES

Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/.

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

©2010American Society of Plastic Surgeons

Login

Article Tools

Images

Share