PI-WIKI-MICRO-26 · Clinical Microbiology · reviewed 2026-10-27
Clinical Microbiology, Recognizing Body-Art Infections
Critical numbers
Normal healing inflammatory windowPeak 24-48h; resolution by 72h, persistence beyond 72h = infection signal
S. aureus nasal carriage rate20-30% of general population
MRSA community prevalenceCarriage about 1-3% in most developed countries; around half of community skin abscesses in some US settings
Pseudomonas perichondritis onsetDays to a few weeks post-procedure
NTM infection latency2-8 weeks post-procedure, the key diagnostic clue
Fever threshold for systemic involvement>38.0°C, immediate medical referral
Perichondritis outcomeAntibiotics alone (early): no deformity; debridement needed: residual deformity in every case (series of 61)
Cauliflower ear riskRises with every day treatment is delayed
Systemic complicationsRare; septic shock, endocarditis and necrotising fasciitis reported after tattooing
NTM treatment duration3-6 months combination antibiotic therapy
Emergency referral signsFever >38°C, rigors, lymphangitic streaking, erythema expanding >1 cm/hour
When to report a cluster≥2 linked cases: report to public health
Do not
- Dismissing a painful
- Recommending OTC antibiotic ointment (bacitracin
- Removing jewellery from an infected piercing
- Assuming MRSA is rare
- Using tap water to dilute tattoo inks or clean equipment
- Failing to report an NTM cluster
Applicable standards
- EU / UK — ECDC
- United States — CDC: Tattoo-associated NTM outbreaks are tracked; the CDC's 2012 report traced…
- ASEAN / AP — WHO Western Pacific Region