Necrotizing fasciitis after breast augmentation: rapid microbiologic detection by using sonication of removed implants and microcalorimetry.

OBJECTIVES To describe the use of sonication and microcalorimetry in diagnosing necrotizing fasciitis in a 27-year-old woman with bilateral breast implants. METHODS The removed breast implants were subjected to sonication and microcalorimetry. The microcalorimetry findings were correlated with conventional microbiologic methods. The time to detection of infection was noted. RESULTS The patient had painful cellulitis of the right breast that enlarged within hours. Her C-reactive protein level was increased. Chest radiograph showed gas formation in the soft tissue lateral of the right breast. Surgery was performed: 300 mL (right breast) and 100 mL (left breast) of serous-purulent fluid were evacuated. Streptococcus pyogenes was cultured from the fluid 1 day after clinical presentation. Infection was diagnosed by microcalorimetry of sonication fluid in 1 hour and 21 minutes. The microcalorimetry curve from the right implant reached the peak earlier than did the left implant. CONCLUSION Microcalorimetry will have a benefit in conditions in which rapid diagnosis of infection is important.