William E. Keene, Ph.D., M.P.H., from the Oregon Department of Human Services, Portland, Ore., and colleagues conducted an investigation of persons who had piercings at a jewelry kiosk from August to September 2000. The health officials sent questionnaires to the customers and collected environmental samples in the kiosk, including countertops, plumbing fixtures, and ear-piercing guns. The kiosk workers were screened for pseudomonas organisms by stool and hand cultures.
"From 186 piercings in 118 individuals, we identified 7 confirmed P aeruginosa infections and 18 suspected infections," the authors write. "Confirmed cases were 10 to 19 years old. Most were initially treated with antibiotics ineffective against Pseudomonas. Four were hospitalized, four underwent incision and drainage surgeries (1 as an outpatient), and several were cosmetically deformed. Upper ear cartilage piercing was more likely to result in either confirmed or suspected infection than was lobe piercing."
The health officials did not find Pseudomonas aeruginosa from any of the solid surfaces at the kiosk. But, it was cultured from 2 of the 4 workers, from an atomizer solution containing a disinfectant, and from waste water in traps beneath the sinks. The authors write that a number of events aligned to cause this outbreak: "First, open piercing guns were used to drive relatively blunt studs through cartilage, rather than recommended (and, in Oregon, legal) alternatives such as needle piercing. Second, a 'single-use' disinfectant bottle was refilled repeatedly, becoming contaminated with P aeruginosa, presumably at the sink where organisms were recovered. Finally, at least 1 worker sometimes sprayed the sterile studs and piercing gun with disinfectant, not appreciating that sterile implements would not benefit from a spray with any disinfectant, much less a contaminated one."
"Clinicians should respond aggressively to potential auricular chondritis (inflammation of the ear cartilage) and consider Pseudomonas a possible cause pending culture results," the authors conclude. (JAMA. 2004;291:981-985. Available post-embargo at JAMA.com )
Editor's Note: This investigation was conducted by public health agencies of the State of Oregon and Klamath County. Much of the former's funding comes from Emerging Infections Program Cooperative agreement, a federal grant. Co-author, Dr. Samadpour donated his laboratory's services without restriction.
JAMA