Pathogen causing infection related to body piercing should be determined

Editor—We accept Ferguson's contention that wearing body jewellery is essentially a personal experience,¹ but such jewellery does have clinical implications.² Maybe Ferguson would not be astonished at having been asked to remove his ornaments if he appreciated that x rays cannot penetrate steel and that the ornaments may have been creating diagnostic difficulties. This would be especially true if computed tomography was being performed. Requests to remove body jewellery may be clinically necessary and should be seen as part of the process of saving a life.

In this era of evidence based medicine, with doctors being urged to reduce use of antibiotics, we were surprised to read the author's recommendation of the blind treatment of infections related to body piercing. Ferguson recommends the use of flucloxacillin on the grounds that these infections are likely to be caused by Staphylococcus aureus, without any supporting evidence. The microbiology of infections related to body piercing has not been determined, although the bacteria associated with surgical sutures and staples have been. These are a mixed flora, with S epidermidis the commonest organism; the bacteria are enveloped in a complex biofilm, which is thought to protect the organism from host defence factors and to account for their persistence on suture surfaces until they are removed with the sutures.³

Genital piercing is more likely to be infected with bacteria from the periurethral microflora. Escherichia coli is the commonest bacterium to cause urinary tract infections,⁴ but it cannot be assumed to remain the infecting pathogen in the presence of a foreign body. Intraoral piercings are likely to be infected with oral commensals.

We believe that body jewellery associated with infection should be removed and an antibiotic decided on after signs of local and systemic dissemination have been examined.