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Oral Antibiotics Do Not Prevent Infection or Implant Loss after Immediate Prosthetic Breast Reconstruction
Mark Sisco1, Kristine Kuchta2, Duanny Alva3
1From the Department of Surgery, Division of Plastic Surgery.
Plastic and Reconstructive Surgery
|February 2, 2023
Summary
Extended antibiotic prophylaxis (EAP) after implant-based postmastectomy breast reconstruction (PMBR) does not improve outcomes and may increase Gram-negative infections. EAP also led to adverse reactions in some patients.
Area of Science:
- Plastic Surgery
- Infectious Disease
- Surgical Oncology
Background:
- Infectious complications are a major cause of morbidity after implant-based postmastectomy breast reconstruction (PMBR).
- Antimicrobial stewardship initiatives aim to reduce postoperative antibiotic use.
- Conflicting data exist on the necessity of extended antibiotic prophylaxis (EAP) following PMBR.
Purpose of the Study:
- To evaluate the efficacy of extended antibiotic prophylaxis (EAP) in preventing infectious complications after implant-based postmastectomy breast reconstruction (PMBR).
Main Methods:
- Retrospective study of 1077 women undergoing prosthetic PMBR from 2008 to 2020.
- Comparison of 90-day outcomes between patients receiving EAP and those not receiving EAP.
- Multivariable logistic regression analysis to assess EAP's impact on infection-related complications.
Main Results:
- No significant differences in surgical-site infection, admission, reoperation, or explantation rates were observed between EAP groups.
- The EAP group had a higher incidence of Gram-negative infections (P < 0.001).
- Adverse reactions, including allergic reactions and Clostridium difficile colitis, occurred in a small percentage of EAP patients.
Conclusions:
- Extended antibiotic prophylaxis (EAP) following PMBR does not enhance clinical outcomes.
- While not worsening overall outcomes, EAP may alter infection microbiology, potentially complicating treatment.
- EAP is associated with a small but significant rate of adverse patient reactions.
