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Published on: May 17, 2024
Microbiology of Implant-Based Breast Reconstruction Infections: A Systematic Review
Joseph Banuelos1, Amjed Abu-Ghname1, Malke Asaad1
1From the Division of Plastic Surgery, Department of Surgery.
Background:
Postsurgical complications have been an increasing concern for hospitals, particularly in light of payment reform. The costs to the health care system are increasing in light of Medicare penalties for readmissions for certain conditions. Surgical site infection following implant-based breast reconstruction (IBR) remains challenging. The rates of positive cultures and isolated microorganisms in IBR are unknown. This systematic review summarizes the reported microorganisms and positive culture rates in the existing literature.
Methods:
A systematic review was performed using the guidelines outlined in Preferred Reporting Items for Systematic Reviews and Meta-analyses. Articles were included if breast implant infection rates and culture results were reported. Further subgroup analysis of culture positive infections was performed.
Results:
A total of 25 studies were included, encompassing 25,177 IBR. Implant infections were reported in 1356 reconstructions (5.4%). Cultures were positive in 74.5% of infections. Gram-positive bacteria were the most common (68.6%), of which Staphylococcus species (51%) was the most isolated pathogen, followed by Pseudomonas. A subgroup analysis showed that early infections (63% vs 88%), radiotherapy (82% vs 93%), and acellular dermal matrix use (90% vs 100%) were associated with lower positive culture rates than their respective counterparts. Patients who received chemotherapy had higher positive culture results (94% vs 83%). Isolated microorganisms also varied among the subgroups.
Conclusions:
This systematic review outlines reported microorganisms in IBR. Staphylococcus species and Pseudomonas were the most frequently reported microorganism. Negative cultures were reported in up to 25.5% of infections. Patients with early infections, radiotherapy, and acellular dermal matrix demonstrated higher negative culture rates. This review can help guide the use of empirical antimicrobial therapy in IBR.
Insights
Surgical site infections in implant-based breast reconstruction (IBR) are common, with Staphylococcus and Pseudomonas being frequent pathogens. Understanding culture results aids in guiding antimicrobial therapy for better patient outcomes.
Area of Science:
- Plastic Surgery
- Infectious Diseases
- Microbiology
Background:
- Postsurgical complications, including surgical site infections (SSIs), are a growing concern in healthcare, impacting costs and hospital payments.
- Surgical site infection following implant-based breast reconstruction (IBR) presents a significant clinical challenge.
- The precise rates of positive cultures and specific microorganisms involved in IBR infections remain largely uncharacterized.
Purpose of the Study:
- To systematically review and summarize reported microorganisms and positive culture rates in implant-based breast reconstruction infections.
- To identify the most common pathogens associated with IBR infections.
- To analyze factors influencing positive culture rates in IBR infections.
Main Methods:
- A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
- Studies reporting breast implant infection rates and culture results were included.
- Subgroup analyses were performed on culture-positive infections to explore influencing factors.
Main Results:
- Twenty-five studies comprising 25,177 IBR cases were analyzed, revealing an overall implant infection rate of 5.4% (1356 reconstructions).
- Cultures were positive in 74.5% of infections, with Gram-positive bacteria being most common (68.6%), predominantly Staphylococcus species (51%).
- Early infections, radiotherapy, and acellular dermal matrix use were associated with higher negative culture rates, while chemotherapy correlated with higher positive culture rates.
Conclusions:
- This systematic review identifies Staphylococcus species and Pseudomonas as the most frequently reported microorganisms in IBR infections.
- A significant proportion of infections (up to 25.5%) yielded negative cultures, particularly in cases of early infection, post-radiotherapy, and acellular dermal matrix use.
- The findings provide valuable insights for optimizing empirical antimicrobial therapy strategies in implant-based breast reconstruction.
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