Sporadic infections following ear piercing are well documented, but
common-source outbreaks are rarely recognized.
To investigate reports of auricular chondritis subsequent to commercial
Design, Setting, and Subjects
Outbreak investigation by Oregon public health agencies, including cohort
study of persons pierced at a jewelry kiosk in August-September 2000, environmental
sampling, and molecular subtyping of isolates. Confirmed cases had Pseudomonas aeruginosa cultured from ear wounds. Suspected cases had
signs and symptoms of external ear infection, including drainage of pus or
blood for at least 14 days.
Main Outcome Measures
Risk factors for infection and comparison of bacterial isolates by molecular
From 186 piercings in 118 individuals, we identified 7 confirmed P aeruginosa infections and 18 suspected infections. Confirmed
cases were 10 to 19 years old. Most were initially treated with antibiotics
ineffective against Pseudomonas. Four were hospitalized,
4 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 (confirmed:
RR undefined, P<.001; suspected: RR, 3.6; 95%
confidence interval, 1.5-8.5). All persons with confirmed infections had their
ear cartilage pierced with an open, spring-loaded piercing gun. Patient isolates
were indistinguishable by molecular subtyping, and matching isolates were
recovered from a disinfectant bottle and nearby sink. At least 1 worker admitted
sometimes spraying the disinfectant on the ear studs before piercing.
Ear cartilage piercing is inherently more risky than lobe piercing.
Clinicians should respond aggressively to potential auricular chondritis and
consider Pseudomonas a possible cause pending culture