Antibiotic Stewardship in Breast Reconstruction
Franca Kraenzlin, Medical Doctor, Kristen Broderick, Medical Doctor.
Johns Hopkins, baltimore, MD, USA.
BACKGROUND: Background: The CDC and the Surgical Care Improvement Project recommend that clean surgical cases receive a maximum of 24 hours of perioperative antibiotics. While breast surgery is considered a clean case, implant based breast reconstruction has decidedly higher rates of infection than the typical 1% to 2% rate of surgical site infections, with studies quoting an up to 50% infection rate. As a result, plastic surgeons prescribe prolonged antibiotic regimens following expander based reconstruction. While retrospective studies looking at antibiotic duration and infection rate have been mixed, a first-in-kind prospective study completed in 2016 found no benefit for prolonged antibiotics. In fact, a prospective non-inferiority randomized trial did find a non-statistically significant trend towards more severe infections and higher explant rates in participants receiving prolonged antibiotics. In this study, we sought to analyze how the use of prolonged antibiotics affect complication severity.
METHODS: A retrospective review of all post mastectomy patients receiving tissue expanders (TE) was completed for 2017 at a University-based academic medical center (n=178).
RESULTS: The average time of immediate post-operative antibiotic administration was 17.8 days, with certain providers sticking to the minimum 14 days per institution pathway, while others prescribed antibiotics until drains were removed. The average total days of antibiotics was 23 days per patient, or 16.2% of the time-period in which they had TEs. The overall infection rate was 16.9% (n=30). The overall rate for RTOR was 18% (n=32) for implant explantation, debridement of infection, positive margins, or debridement of necrotic mastectomy flaps. The overall rate for RTOR for explantation due to infection was 10.1% (n=18). Individuals who received perioperative antibiotics longer than 14 days had equal infection rates to those who received perioperative antibiotics for less than 14 days (16.1% vs. 17.2%, p value = 0.85, respectively). Individuals who received perioperative antibiotics longer than 14 days had a non-statistically significant trend to higher explantation rates (22.6% vs 12.1%, p value = 0.066, respectively).
CONCLUSIONS: In-line with the prospective study, this study does not demonstrate decreased infection rates in individuals who receive longer perioperative antibiotics. However, there is a trend towards higher rates of explantation in individuals who receive longer periods of perioperative antibiotics. Breast reconstruction surgery continues to be rife with complication, and the lack of antibiotic stewardship may be an important contributor to the morbidity that patients face. Further prospective studies limiting perioperative antibiotics should be completed to further elucidate this problem.
Back to 2018 Posters
