Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

Abstract

Background: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. Methods: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. Results: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. Conclusion: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.

Effectiveness of Single vs Multiple Doses of Prophylactic Intravenous Antibiotics in Implant-Based Breast Reconstruction

“…None of these studies nor one small randomized study could show a reduction of SSI rates through prolonged prophylaxis exceeding 24 hours after implant-based breast reconstruction. Even though a single preoperative antibiotic dose offers sufficient SSI prevention in breast augmentation surgery, extended antibiotic prophylaxis is commonly given . It is important to consider in the context of an increased risk of acquired antibiotic resistance through extended antibiotic prophylaxis .…”

“…Even though a single preoperative antibiotic dose offers sufficient SSI prevention in breast augmentation surgery, 35 extended antibiotic prophylaxis is commonly given. 36 , 37 It is important to consider in the context of an increased risk of acquired antibiotic resistance through extended antibiotic prophylaxis. 20 The main aim of this prospective randomized clinical trial was to investigate whether single-dose or multiple-dose antibiotic prophylaxis is most effective in preventing implant removal and reducing SSI rates.…”

The Impact of Postoperative Antibiotic and Duration After Implant-Based Breast Reconstruction on Resistance Among Cultured Species

“…Nevertheless, many plastic surgeons routinely prescribe 1 to 2 weeks of antibiotics after IBBR despite a lack of evidence supporting the efficacy of such a strategy to prevent or decrease SSIs. Although frequently regarded with ambivalence, prolonged prophylactic antibiotic courses are not benign; they not only confer increased cost to the health care system but also pose real risk to patients including increased systemic medication adverse effects, Clostridium difficile , as well as increased risk of drug-resistant organisms 4,8 . These risks are particularly consequential among medically vulnerable people, which include the cancer patient population undergoing IBBR.…”

Variation in practice for preoperative antibiotic prophylaxis: a survey from an academic tertiary referral center in the United States

“…Similarly, in hip fracture surgery, a study reported almost 50 % reduction in the rate of SSI with the use of antibiotic prophylaxis compared to without [ 2 ]. However, despite best practice guidelines and the known efficacy of antibiotic prophylaxis in reducing the risk of SSI, there is evidence of wide variation in antibiotic prophylaxis practices [ 7 – 9 ]. A study involving 2,965 hospitals, including 34,133 patients, determined that only 56 % of patients received antibiotic prophylaxis within 60 min of the incision and another 20 % of the patients received antibiotics between one and two hours before incision [ 7 ].…”