Oral antibiotics do not prevent infection or implant loss after immediate prosthetic breast reconstruction: Evidence from 683 consecutive reconstructions without prophylaxis.

Abstract

Background: Infectious complications following implant-based postmastectomy breast reconstruction (PMBR) are a significant cause of morbidity. Nationwide, antimicrobial stewardship efforts have sought to reduce the use of prophylactic antibiotics postoperatively. However, there are conflicting data regarding the utility of extended antibiotic prophylaxis (EAP) after PMBR, and many surgeons continue to prescribe them. Methods: The authors conducted a retrospective study of 1077 women who underwent immediate prosthetic PMBR from January of 2008 to May of 2020. All patients received intravenous antibiotics preoperatively and up to 24 hours postoperatively. Before October of 2016, patients were also prescribed oral antibiotics until drain removal; thereafter, this practice was abandoned. Ninety-day outcomes were compared between EAP-positive and EAP-negative patients. Descriptive statistics and multivariable logistic regression analysis were used to assess the efficacy of EAP in preventing infection-related complications. Results: There were 1004 breasts in the EAP-positive group and 683 in the EAP-negative group. Three hundred sixty-one reconstructions (21.4%) were prepectoral. Multivariable analysis demonstrated no difference in surgical-site infection (OR, 0.83; 95% CI, 0.56 to 1.25; P = 0.38), admission (OR, 0.78; 95% CI, 0.41 to 1.48; P = 0.44), reoperation (OR, 1.01; 95% CI, 0.68 to 1.48; P = 0.97), or explantation rates (OR, 1.06; 95% CI, 0.66 to 1.71; P = 0.81) between the EAP groups. The EAP-positive group was more likely to develop Gram-negative infections (P < 0.001). Thirteen EAP-positive women (2.0%) developed allergic reactions, and four (0.6%) developed Clostridium difficile colitis attributable to the EAP. Conclusions: EAP after PMBR did not improve outcomes. Although use of EAP did not appear to worsen clinical outcomes, marked differences in the microbiology of associated infections may render them more difficult to treat. Moreover, a small but significant proportion of women experienced adverse reactions to the EAP. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Effect of prolonged antibiotic prophylaxis on the occurrence of surgical site wound infection after instant breast reconstruction: A meta‐analysis

“…Following an assessment of 675 relevant papers, 18 papers that were released between 2009 and 2023 were included in the meta‐analysis since they matched the inclusion criteria 11,12,24–39 . Table 2 summarises the findings of these investigations.…”

“…The sample size was 37-7398 people. 11,12,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The examined data revealed that systemic antibiotic prophylaxis had a T A B L E 1 Database search strategy for inclusion of examinations.…”

“…For the current meta‐analysis, 18 exams from 2009 to 2023 were included; of these, 19 301 females with instant breast reconstruction were in the used studies' starting point; 12 235 of them utilised systemic antibiotic prophylaxis; 489 of them utilised topical systemic antibiotic prophylaxis; and 6577 of them utilised standard of care. The sample size was 37–7398 people 11,12,24–39 . The examined data revealed that systemic antibiotic prophylaxis had a significantly lower surgical site wound infection rate compared with the standard of care after instant breast reconstruction in females.…”

Optimizing Surgical Outcomes and the Role of Preventive Surgery: A Scoping Review

“…86 Antibiotics and drain placement are routinely used to reduce postoperative infection and seromas, but effectiveness depends on timing, duration, procedure, and patient risk factors. 87,88 While literature suggests postoperative approaches such as NPWT, antibiotics, and…”

Prophylactic Absorbable Antibiotic Beads for High-risk, Implant-based Prepectoral Reconstruction

“…[5][6][7][8][9] A prolonged course of systemic, oral antibiotics has not shown evidence-based benefit. 10,11 Selective, prophylactic, local delivery of antibiotics may provide the therapeutic effect of antibiotics while avoiding systemic side effects and other issues of antibiotic overuse. 12,13 Absorbable antibiotic beads have been well described for orthopedic procedures for osteomyelitis, as well as pressure sore reconstruction for ulcer recurrence, and vascular graft infection.…”