Does a Post-Operative Course of Antibiotics Decrease Infections in Implant Based Reconstruction Following Mastectomy versus Peri-Operative Antibiotics Alone: A Meta-Analysis
Cristin Coquillard, MD, Katherine Grunzweig, MD, Corinne Wee, MD, Peter Fellowes, MS, Anand Kumar, MD.
University Hospitals Cleveland Medical Center Division of Plastic Surgery, Cleveland, OH, USA.
BACKGROUND: Post-operative infection is the most common complication of implant based reconstruction following mastectomy, occurring in approximately 5-15% of patients. This can cause significant morbidity including implant loss, delay in final reconstruction, increased risk of capsular contracture, and psychological stress. Despite the significant impact of this complication, there is no current consensus regarding duration of prophylactic antibiotics. We hypothesize that there is no difference in infection rates between patients receiving peri-operative antibiotics alone versus a post-operative course. The aim of this study was to evaluate rates of infection amongst patients receiving different antibiotic regimens.
METHODS: A comprehensive search of the Pubmed, Medline, and Science Direct databases was performed for studies comparing infection rates in implant based reconstruction with various antibiotic regimens. Primary outcome evaluated was breast infection associated with prosthesis. Peri-operative antibiotics were defined as a course of 24 hours or less. Any antibiotic course extending beyond 48 hours after surgery was classified as a post-operative antibiotic course. A Cochran-Mantel-Haenszel test was applied to determine if there was a difference in infection rate with peri-operative antibiotics alone versus continuing with a post-operative course of antibiotics in the context of the heterogeneity of the studies.
RESULTS: An initial search identified 1,474 studies; 10 studies met inclusion criteria, which examined a total of 8,255 breast reconstruction cases. 1,942 patients received peri-operative antibiotics only, while 6,313 received a post-operative antibiotic course. Infection rates were not statistically significant between the two groups, with 196 reported infections (10%) in the peri-operative antibiotic group versus 537 (8.5%) in the post-operative antibiotic group (p=0.13).
CONCLUSIONS: This study suggests that there is no statistically significant difference in infection rates between a peri-operative course of antibiotics alone versus a more prolonged post-operative course in implant-based breast reconstruction following mastectomy. While there may be benefit to post-operative antibiotics, risks such as development of resistant bacterial strains and Clostridium difficile infection must also be considered. Further studies are warranted to evaluate the impact of factors such as the use of acellular dermal matrix, drain duration, and medical comorbidities.
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