The Impact of Penicillin Allergy on Infection Rates in Tissue Expander Breast Reconstruction: A 7-year Analysis

Area of Science:

• Plastic Surgery
• Infectious Disease
• Antimicrobial Stewardship

Background:

• Penicillin-allergic patients often receive alternative antibiotics for breast reconstruction, deviating from guidelines favoring cefazolin.
• These alternative regimens may be less effective, and cefazolin use is not widely adopted.
• This study examines infectious complications in penicillin-allergic versus non-allergic patients undergoing breast reconstruction.

Purpose of the Study:

• To evaluate differences in infectious complications, preoperative antibiotic use, and prophylaxis timing.
• To compare infection rates between penicillin-allergic and non-penicillin-allergic patients.
• To investigate the impact of antibiotic administration timing on infection outcomes.

Main Methods:

• Retrospective review of patients undergoing tissue expander breast reconstruction (2015-2022).
• Comparison of infectious complication rates between penicillin-allergic and non-penicillin-allergic groups.
• Analysis of secondary outcomes including infection onset timing and relation to antibiotic prophylaxis timing.

Main Results:

• Penicillin allergy was reported in 22.4% of 427 patients.
• Infection rates were significantly higher in penicillin-allergic patients (37.5%) compared to non-allergic patients (23.8%).
• Shorter antibiotic administration-to-incision intervals were associated with infection in patients receiving clindamycin.

Conclusions:

• Penicillin-allergic patients had significantly higher infection rates in this breast reconstruction cohort.
• The increased risk may be linked to alternative antibiotic use (e.g., clindamycin) and shorter prophylactic intervals.
• Factors related to penicillin allergy and local antibiograms may also contribute to observed infection rates.