The Use of Next Generation Sequencing to Detect Pre-Clinical Implant Infections: The Future of Microbiology
Jaime L. Bernstein*1, Anna M. Vaeth2, Karina Condez2, Kristen Castellano2, Grant G. Black2, David Otterburn2
1NewYork Presbyterian-Cornell/Columbia, New York, NY; 2Surgery, Weill Cornell Medicine, New York, NY
Detection of implant infection, prior to clinical symptoms, could decrease the rates of implant loss. Next generation sequencing (NGS) uses polymerase chain reaction to identify with precision a large spectrum of microbial DNA at a low cost, without the biases of traditional culture. Our standard method of breast reconstruction is drainless with a dual chamber tissue expander (TE) in the pre-pectoral plane. This method provides the unique ability to sterilely sample and study the fluid surrounding the implant using NGS to better understand when implant infections arise and if peri-prosthetic fluid could detect infections earlier.
This is a single institution, prospective study of patients undergoing mastectomy, with pre-pectoral, drainless, TE reconstruction. Peri-prosthetic fluid was collected through the TE drainage port in the operating room immediately after closure, at 1 week post op, and 3 weeks post op. This fluid was sent for traditional culture and NGS. Patients were also observed for signs of infection, need for antibiotics, return to OR, or implant loss. Charts were reviewed for patient demographics.
22 breasts from 13 patients were included in the study with a mean age of 49 and BMI of 25. 5 patients were smokers, 3 received chemotherapy and 3 underwent radiation. The average length of drainage needed was 21 days post-operative. NGS detected microorganisms in 5 breasts, all susceptible to cefalexin, for which patients were treated with at each drainage. Regular culture detected microorganisms in 2 breast samples. During the study, there were no clinical implant infections, no return to the OR, or implant loss.
Detection of implant infections before they become clinically symptomatic could significantly decrease the rate of implant loss. Although this this is a pilot study, these preliminary results are promising that peri-prosthetic fluid monitoring with NGS has the potential to detect implant infections before clinical symptoms arise and significantly decrease the rates of implant infection and loss with more targeted antibiotic treatment.
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