Infectious Adverse Events Following Acupuncture: Clinical Progress and Microbiological Etiology.

BACKGROUND: We investigated the clinical progress and bacteriological characteristics of infectious adverse events (AEs) following acupuncture and compared patient characteristics between serious and non-serious outcome groups. METHODS: A retrospective observational study was conducted in 1,174 patients with infectious complications associated with acupuncture at the emergency department (ED) in a tertiary hospital in Korea between 2010 and 2014. Serious outcome was defined as development of septic shock, admission to intensive care unit (ICU) or attaining permanent morbidity. RESULTS: Forty-eight patients had certain causality and cellulitis, necrotizing fasciitis and osteomyelitis were common in order. Among them, 9 patients (18.8%) were categorized into serious outcome group, and they showed devastating outcomes such as septic shock (n = 2), ICU admission (n = 4), and permanent sequelae (n = 5). The serious group had delayed admission to the ED after acupuncture (30.0 [4.0-55.0] vs. 3.0 [1.0-10.0] days, P = 0.023). Methicillin-sensitive Staphylococcus aureus was the most frequently identified microorganism. The patients in the serious group required longer treatment duration (139.0 [49.0-183.5] vs. 14.0 [7.0-34.0] days, P < 0.001) as well as more operation with local (44.4% vs. 10.3%, P = 0.031) or general anaesthesia (33.3% vs. 2.6%, P = 0.017). CONCLUSION: The infectious AEs after acupuncture may cause serious outcomes. Patients and primary physicians should be aware of the risk of infectious complications and make efforts to prevent them.

Safety Concerns with Thoracoabdominal Acupuncture: Experience at a Tertiary-Care Emergency Department.

OBJECTIVE: To evaluate serious complications caused by acupuncture treatment and to increase awareness of this complication. DESIGN: A retrospective observational study. SETTING: At the emergency department of a tertiary hospital in an urban area during a five-year period (2010-2014) in Seoul, Korea. SUBJECTS: Patients with postacupuncture mechanical complications in the thoracoabdominal region. METHODS: All cases were independently assessed for inclusion by two emergency physicians based on the causal relationship between acupuncture and emergency department presentation. RESULTS: There were 10 cases of pneumothorax (one combined with pneumomediastinum) and two cases of pneumoperitoneum induced by acupuncture. Five of the 12 patients were male; the mean age was 43.4 years. The mean time between acupuncture and emergency department admission was 1.6 days. The pneumothorax was unilateral in eight cases and bilateral in two. Eight patients underwent tube thoracostomy (pig tail catheter or chest tube insertion) and were admitted to the hospital for a median of 11 days. Of the two patients with pneumoperitoneum, one was transferred to another hospital for emergency surgery and the other was admitted to our hospital after emergency total colectomy. CONCLUSIONS: Life-threating complications such as pneumothorax and bowel perforation after acupuncture can occur, and this suggests that physicians, especially acupuncturists, should be aware of the risk associated with needling around the trunk region. To maximize the safety of acupuncture, adequate competency-based training should be provided.