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Postdischarge prophylactic oral antibiotics do not decrease the risk of infection in implant-based breast reconstruction
Patricia Fuentes
*, Eva Ingber, Olivia Becker, Emma Lascar, Sahil Sharma, Sheuli Chowdhury, Peter J. Taub, Peter W. Henderson
Plastic and Maxillofacial Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
IntroductionSurgical site infections (SSI) following implant-based breast reconstruction (IBBR) can lead to implant infection and reoperation. To avoid this complication, patients are often discharged with extended courses of prophylactic oral antibiotics. Prolonged antibiotic use can increase risk of adverse events and resistance, and there is no consensus on optimal discharge prophylaxis. Therefore, the objective of this study was to evaluate whether oral antibiotics prescribed at discharge reduced the risk of postoperative SSI or implant infection following IBBR.
MethodsAll female patients undergoing IBBR at a single academic center (2014-2023) were included. Patients were stratified by antibiotic duration: inpatient antibiotics only, 1-7 days postdischarge, and ≥8 days postdischarge. Demographics, comorbidities, operative details, and postoperative complications were collected. The primary outcomes were SSI and implant removal due to infection. Outcomes were compared with Pearson chi-square or Fischer's exact test for categorical variables, and Mann-Whitney U for continuous variables. Kaplan-Meier analysis was conducted to evaluate time to SSI. Significance was set at p<0.05.
ResultsAmong 527 who underwent IBBR, 55 (10.4%) received inpatient antibiotics only, 335 (63.6%) received 1-7 days of postdischarge antibiotics, and 136 (25.8%) received ≥8 days. No differences were observed between groups in rates of SSI (3.6% inpatient only vs 9.2% 1-7 days vs 5.1% ≥8 days; p = 0.160) or implant removal due to infection (3.6% inpatient only vs 2.7% 1-7 days vs 0.7% ≥8 days; p = 0.341). Kaplan-Meier analysis demonstrated no difference in time to SSI based on antibiotic duration (p=0.163). There were no differences in SSI treatment type (oral vs intravenous vs both) between antibiotic duration groups (p=0.765).
ConclusionPostdischarge prophylactic oral antibiotics may not decrease the risk of surgical site infection or implant infection following implant-based breast reconstruction.
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