High-volume calcium hydroxylapatite filler to the lower one-third of the face.

infections, it can also cause highly invasive and potentially lethal infections, including necrotizing pneumonia, septic cavernous sinus thrombosis, and pyogenic brain abscess. The fulminant nature of these unusual cases has led many investigators to speculate that CA-MRSA may be more virulent than HA-MRSA. In fact, CA-MRSA strains have been shown to be more virulent than HA-MRSA in neutrophil survival and murine infection studies; however, the factors that may make CA-MRSA more virulent or transmissible have not yet been clearly defined. Herein, we present a case of surgical site infection after face-lift surgery caused by the epidemic strain of CAMRSA USA300. At least 1 of the cases of MRSA face-lift wound infection described by Zoumalan and Rosenberg was also likely caused by a CA-MRSA strain based on the antibiotic susceptibility pattern of the isolate, but molecular analysis was not performed. To our knowledge, this is the first report of death attributable to an infection complicating face-lift surgery and the first fatal case of septic dural sinus thrombosis caused by CAMRSA. In the preantibiotic era, uncontrolled infections of the face were a common cause of septic dural sinus thromboses, and mortality rates of these now-rare conditions remain high in the modern era (30% for septic cavernous sinus thrombosis, 78% for septic sagittal sinus thrombosis). The emergence of MRSA as a CA pathogen will likely be an ongoing challenge in the care of ambulatory surgery patients. All MRSA wound infections should be treated aggressively with surgical drainage and appropriate antibiotic therapy. A recent study reporting a higher than 90% cure rate of uncomplicated CA-MRSA skin abscesses with incision and drainage combined with either a placebo or an antibiotic predicted to be ineffective (cephalexin) is yet another clear demonstration of the primacy of surgical drainage in the treatment of these infections. Less clear and in need of study are the optimal methods to identify, treat, and prevent disease in ambulatory patients at risk for MRSA surgical site infections. In conclusion, emergence of MRSA within the community represents a clear and present danger to individuals traditionally considered to be at low risk for MRSA infection, including those undergoing ambulatory surgical procedures.