Occult gram-negative bacterial colonization of explanted alloplastic implants incidentally detected during revision...

Postoperative infection following rhinoplasty is uncommon but can have serious consequences, particularly after revision procedures. Latent bacterial colonization and biofilm formation on implanted materials may contribute to delayed or subclinical infection, yet microbiologically confirmed colonization of implants in fully asymptomatic patients is rarely documented, and Gram-negative organisms are seldom reported in this setting.

A 35-year-old woman underwent revision rhinoplasty for a persistent nasal deformity after ten prior procedures involving alloplastic materials and autologous cartilage. She had no clinical signs of infection and had normal laboratory findings. Previously implanted expanded polytetrafluoroethylene (ePTFE) and residual cartilage grafts were explanted, and intraoperative nasal fluid from the implant pocket was cultured, yielding Enterobacter aerogenes with an AmpC-type phenotype (resistant to third-generation cephalosporins and susceptible to cefepime, carbapenems, aminoglycosides, and fluoroquinolones). Because viable Gram-negative organisms were confirmed adjacent to a newly placed autologous costal cartilage framework, a targeted 7-day course of meropenem and amikacin was given according to susceptibility testing to protect the reconstruction. At the 3-month follow-up, the surgical site was stable with no evidence of infection.

Viable bacteria may persist on implanted materials without clinical manifestations, consistent with biofilm formation. As no clinical, laboratory, or intraoperative signs of infection were present, the finding is best characterized as occult (latent) colonization rather than active infection and may be overlooked during revision rhinoplasty.

Latent bacterial colonization of previously implanted materials in revision rhinoplasty may be under-recognized. Routine microbiological evaluation of explanted materials may facilitate early detection and guide postoperative management.