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

Abstract

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.

A Modified Enhanced Recovery after Surgery (ERAS): Use and Surgical Outcome in Breast Cancer Patients

“…A systematic review demonstrated that prophylactic antibiotics administered preoperatively significantly reduce the incidence of SSI in BC surgery when compared with placebo [22]. This is in contrast to the findings in a retrospective observational study that suggest that a single dose of preoperative antibiotic was not associated with a lower SSI rate of elective, non-reconstructive breast operations [23]. In our practice, we administer a single dose prophylactic intravenous antibiotic before skin incision only in selected cases identified as high risk for SSI.…”

Complicaciones postoperatorias en mujeres con cirugía por cáncer de mama

“…En este estudio se encontró que el 23% la presentó, además que fue catalogada como complicación temprana, ya que su aparición va desde los 17 días después de haber egresado del hospital. A partir de estos resultados tal vez sea necesario reestructurar los procesos de cuidados pre, trans, postoperatorios, así como la educación a la paciente y su familia para el manejo de sus heridas en el hogar, a fin de evitar este tipo de complicación, por ejemplo: la higiene de manos intrahospitalario y en el hogar, curación de herida, uso de antibioticoterapia 19 , entre otros.…”

Surgical Site Infection after Breast Surgery: Retrospective Analysis of 5-year Postoperative Data from a Single Center in Poland

“…Recent reviews of the database of the National Surgical Quality Improvement Program demonstrated that 1.4-3.2% of patients develop SSI after breast surgery [8][9][10]. However, other studies reported that the rate of SSI is up to 36% following specific procedures such as modified radical mastectomy [11,12]. In the current study, the incidence of SSI was higher in patients who underwent subcutaneous amputation with simultaneous reconstruction using an artificial prosthesis and breast reconstruction via the TRAM flap method than in patients who underwent classic breast surgery and breast-conserving surgery.…”