Does Preoperative Core Needle Biopsy Increase Surgical Site Infections in Breast Cancer Surgery? Randomized Study of Antibiotic Prophylaxis

Paajanen, Hannu; Hermunen, Heikki

doi:10.1089/sur.2008.078

Cited by 16 publications

(10 citation statements)

References 13 publications

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“…The procedure from which CNBs can be obtained allows for a more limited contamination of specimens even if the tissue levels are lower than those of SEBs. Indeed, even though breast tissues drawn from SEBs were obtained under fully aseptic conditions, surgical excision involves an unavoidable exposure to the external environment 34 , 35 . However, in the present study, the collection of environmental controls showed that such external contamination was undetectable.…”

Section: Discussionmentioning

confidence: 99%

Characterization of human breast tissue microbiota from core needle biopsies through the analysis of multi hypervariable 16S-rRNA gene regions

Costantini

Magno

Albanese

et al. 2018

Sci Rep

103

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Breast microbiota compositions are not well understood, and a few recent reports have begun to explore the correlation between breast tissue dysbiosis and cancer. Given that various methods for breast microbiota detection were used, the aim of the present paper was to clarify which hypervariable region of the 16S-rRNA gene (V2, V3, V4, V6 + 7, V8, and V9) is the most informative for breast tissue microbiota. Core needle biopsies (CNBs) were compared with surgical excision biopsies (SEBs) to find a less invasive form of recovery useful for the analysis of a larger statistical population and potentially for diagnostic use of breast tissue microbiota. Finally, this study was the first to analyse the breast microbiota of tumours and paired normal tissues of a Mediterranean population. Our findings showed that the V3 region is the most informative for breast tissue microbiota, accounting for 45% of all reads. No significant differences were found between CNB and SEB specimens in terms of total reads and numbers of Operational Taxonomic Units (OTUs). Moreover, we find that more similarities than differences exist between tumours and adjacent normal tissues. Finally, the presence of the Ralstonia genus is associated with breast tissue.

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Section: Discussionmentioning

confidence: 99%

Characterization of human breast tissue microbiota from core needle biopsies through the analysis of multi hypervariable 16S-rRNA gene regions

Costantini

Magno

Albanese

et al. 2018

Sci Rep

103

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“…Assuming a 5% absolute difference in SSI rates between patients who received a single preoperative dose of antibiotic and those who did not, a minimum of 400 cases and 400 controls were necessary to attain 80% statistical power. This was based on an expected difference of SSI rates from 8% for the patients who did not receive any antibiotics to 3% for those who received a single dose of preoperative antibiotic [ 6 , 7 , 9 – 11 , 14 – 16 ]. In the bivariable analysis, a Z -/ t -test was used for normally distributed data, Wilcoxon Rank-Sum test for skewed data, and Fisher's Exact or Chi-square test for categorical data.…”

Section: Discussionmentioning

confidence: 99%

Surgical Site Infections in Breast Surgery: The Use of Preoperative Antibiotics for Elective, Nonreconstructive Procedures

Crawford

Clay

Seydel

et al. 2016

International Journal of Breast Cancer

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Background. Antibiotic prophylaxis for surgical site infections (SSIs) for breast surgery is widespread, but the benefit in clean surgical cases is not well defined. Methods. A retrospective analysis of 855 patients undergoing elective, nonreconstructive breast operations was performed, with 401 patients receiving no antibiotics and 454 patients receiving a single dose of preoperative antibiotic. Results. Administration of a preoperative antibiotic did not decrease the SSI rate. In this community-based study, antibiotic use practices varied considerably by surgeon. In univariate analyses, SSI rates appeared to increase with prophylactic antibiotic use (12% SSI with antibiotics versus 4% without, p < 0.0001), likely because the use of underdosed antibiotics was associated with higher rates of SSI (13.2% SSI with cefazolin 1 gram, p < 0.0001, and 15.4% SSI with clindamycin 300 mg or less, p = 0.0269). Methicillin-resistant Staphylococcus aureus was the most common isolate from SSI cultures, 31.8% (7 of 22). In multivariable analyses, increased risk of SSI was associated with BMI > 25 kg/m2 (OR: 1.08, 95% CI: 1.04–1.11, p < 0.0001). Conclusion. The administration of a single dose of preoperative antibiotic did not decrease the rate of SSI in this large series of patients undergoing clean breast operations. BMI >25 kg/m2 and the use of an inadequate dose of antibiotics for prophylaxis may increase risk of SSI.

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“…1. Nine randomized controlled trials (23–31) encompassing 3,720 patients undergoing breast surgery were retrieved from the electronic databases for systematic review. To generate a summated outcome, we divided patients into two groups: an antibiotics group and non‐antibiotics group (patients received either no antibiotics or a placebo).…”

Section: Resultsmentioning

confidence: 99%

“…Preoperative prophylactic antibiotics are recommended in many surgical disciplines to reduce the SSI‐related morbidity and cost (18); however, recent published studies on various clean surgical procedures have not favored the routine use of antibiotics prophylactically (19–22). Randomized controlled trials (23–31) and previously published reviews in 2006 (32,33) reported equivocal results on the effectiveness of prophylactic antibiotics in the reduction of breast SSI. The objective of this article is to re‐visit and re‐evaluate the role of preoperative prophylactic antibiotics in patients undergoing breast surgery in terms of reduction in SSI rate.…”

mentioning

confidence: 99%

An Updated Meta-Analysis on the Effectiveness of Preoperative Prophylactic Antibiotics in Patients Undergoing Breast Surgical Procedures

et al. 2012

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To systematically analyze published randomized trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures. Trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgery were selected and analyzed to generate summated data (expressed as risk ratio [RR]) by using RevMan 5.0. Nine randomized controlled trials encompassing 3720 patients undergoing breast surgery were retrieved from the electronic databases. The antibiotics group comprised a total of 1857 patients and non-antibiotics group, 1863 patients. There was no heterogeneity [χ(2) = 7.61, d.f. = 7, p < 0.37; I(2) = 8%] amongst trials. Therefore, in the fixed-effects model (RR, 0.64; 95% CI, 0.50-0.83; z = 3.48; p < 0.0005), the use of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures was statistically significant in reducing the incidence of surgical site infection (SSI). Furthermore, in the fixed-effects model (RR, 1.30; 95% CI, 0.89-1.90; z = 1.37; p < 0.17), adverse reactions secondary to the use of prophylactic antibiotics was not statistically significant between the two groups. Preoperative prophylactic antibiotics significantly reduce the risk of SSI after breast surgical procedures. The risk of adverse reactions from prophylactic antibiotic administration is not significant in these patients. Therefore, preoperative prophylactic antibiotics in breast surgery patients may be routinely administered. Further research is required, however, on risk stratification for SSI, timing and duration of prophylaxis, and the need for prophylaxis in patients undergoing breast reconstruction versus no reconstruction.

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Does Preoperative Core Needle Biopsy Increase Surgical Site Infections in Breast Cancer Surgery? Randomized Study of Antibiotic Prophylaxis

Abstract: Core needle biopsy did not increase the incidence of SSI. Antibiotic prophylaxis did not prevent SSI, probably because so few infections occurred.

Cited by 16 publications

References 13 publications

Characterization of human breast tissue microbiota from core needle biopsies through the analysis of multi hypervariable 16S-rRNA gene regions

Characterization of human breast tissue microbiota from core needle biopsies through the analysis of multi hypervariable 16S-rRNA gene regions

Surgical Site Infections in Breast Surgery: The Use of Preoperative Antibiotics for Elective, Nonreconstructive Procedures

An Updated Meta-Analysis on the Effectiveness of Preoperative Prophylactic Antibiotics in Patients Undergoing Breast Surgical Procedures

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