Avaliação da contaminação microbiológica em seringas de ácido hialurônico após o armazenamento de preenchedores e capacidade de formação de biofilme por Staphylococcus epidermidis

Abstract

Injectable soft tissue fillers can provide an important component of facial regeneration in terms of restructuring and restoring volume without considerable patient inconvenience and long recovery time. Hyaluronic acid (HA) gel fillers are the most commonly used materials for dermal purposes to augment soft tissue due to their properties and advantages over other alternative fillers. One of the main disadvantages, that is, associated with the use of fillers, is the contamination and possible infection that could occur due to the properties of the material itself, the inappropriate use of the product or the lack of sterilization conditions. Typically, injectors during the procedure do not use up the entire filling syringe at once, and store the remaining material for later use, to complete the treatment of patients due to the high associated cost. However, one of the main concerns associated with storing fillers to be reused is the possibility of microbial contamination. This practice is not recommended by the filler manufacturers, as the sterility of opened products is not guaranteed. Previous experiments have shown that different species of bacteria can grow in a medium like hyaluronic acid and develop a robust biofilm. Biofilms can be defined as an agglomeration of bacterial cells embedded in a matrix. Once the biofilm is formed, it is not easily penetrated by the innate immune system or by any antibiotic. Ampicillin is one of the main antimicrobial agents used for the treatment of infections associated with biofilms formed by Staphylococcus epidermidis in HA filling materials. Antibiotic pressure generally produces small colony varients (SCVs) in S. epidermidis biofilms. SCVs are characterized as small-growth subpopulations of bacteria with altered physiological and biochemical characteristics. The objective of this research project is to isolate and identify bacteria and fungi in HA gels and used needles. We will also study in vitro the ability of S. epidermidis to form a biofilm on a HA surface, in addition to the possibility that ampicillin treatment on the biofilm will enable the generation of SCVs.