Abstract P1-20-09: Does a single-dose of pre-operative prophylactic antibiotic reduce surgical site infection following wire-localized lumpectomy?

Abstract

Background: Data on the benefits of preoperative prophylactic antibiotics for breast surgery are conflicting and there is no guideline for their use for wire-localized lumpectomy. The aims of this study were to determine whether a single dose of pre-operative antibiotic reduces surgical site infection (SSI) for wire-localized lumpectomy and to identify risk factors for SSI. Methods: This was a prospective randomized trial carried out from April 2018 to June 2019 at the “Centre des Maladies du Sein du CHU de Québec - Université Laval”, a tertiary center specialized in breast surgery. After informed consent, patients who underwent wire-localized lumpectomy were randomized to receive or not a pre-operative single dose of prophylactic antibiotic (cefazolin 2 g or clindamycin 900 mg in case of penicillin allergy). Data regarding demographics, comorbidities, perioperative details, and SSI were analyzed. SSI was considered if: 1) patient had positive wound cultures; or 2) required abscess drainage; or 3) received antibiotic treatment for breast symptoms (e.g., important erythema, congestion) within 30 days after operation, in the absence of wound culture or in the presence of negative results. The investigator responsible for data collection was blind to grouping. All patients were called 30 days after surgery to be sure that they did not consult at another hospital for surgical wound infection. Results: A total of 326 patients were enrolled. Eighteen patients were excluded because they retired their consent or because grouping was not respected in the operating room. The two groups were similar for demographic data, perioperative details, and comorbidities. The overall SSI rate was 4.6% (14/308), and more specifically 3.1% (5/159) in the antibiotic group and 6.0% (9/149) in the no antibiotic group (P=0.28). The frequency of having a body mass index >30 kg/m2 was higher among patients with SSI (SSI: 57.1% (8/14); no SSI: 21.8% (64/294); P=0.006). Among the patients with obesity who developed a SSI (n=8), three (37.5%) did receive a prophylactic antibiotic. Age, diabetes, hypertension, smoking, neoadjuvant chemotherapy, history of radiotherapy, past history of chemotherapy, second surgery, ASA ≥3, surgical time >30 min, number of wires, technique for wire insertion, lymph node excision, and oncoplasty were not associated with SSI. All cases of SSI were treated routinely by antibiotic treatment; one patient required wound re-opening. None of the SSI delayed any adjuvant treatment. Conclusion: Our SSI rate (4.6%) for wire-localized lumpectomy is superior to that of the existing literature (2.0-2.3%), but the SSI definitions varied among those previous studies and with the present one. None of the cases was proven by positive cultures (either not done or negative), and overtreatment of a possible SSI is a possibility. The results suggest that it is safe to omit prophylactic antibiotic for wire-localized lumpectomy since it does not seem to reduce SSI significantly. Omitting prophylactic antibiotic could decrease the costs of surgery and avoid side effects. Citation Format: Gabrielle Bergeron Giguère, Brigitte Poirier, Louise Provencher, Dominique Boudreau, Dominique Leblanc, Eric Poirier, Jean-Charles Hogue, Christine Desbiens. Does a single-dose of pre-operative prophylactic antibiotic reduce surgical site infection following wire-localized lumpectomy? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-09.