Craft Randall O, Damjanovic Branimir, Colwell Amy S
Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ann Plast Surg. 2012 Oct;69(4):446-50. doi: 10.1097/SAP.0b013e31824a215a.
Immediate breast implant reconstruction has among the highest incidence of infections in plastic surgery. A literature search returned key articles that showed a significant decrease in surgical-site infections by performing nasal swab evaluation to treat methicillin-sensitive and methicillin-resistant Staphylococcus aureus before surgery with mupirocin nasal ointment and 5 days of chlorhexidine scrub to the surgical area. Additional Level 1 data supported the use of chlorhexidine-alcohol over povidone-iodine solutions for skin preparation. Intraoperative data on breast pocket irrigation showed the benefits of povidone-iodine as well as a triple antibiotic solution. Nasal swabs from 120 patients showed no methicillin-resistant S. aureus but did identify 10 patients with methicillin-sensitive S. aureus, 1 with streptococcus, and 3 with gram-negative rods, which changed perioperative antibiotic management. On the basis of the previously mentioned data, an evidence-based protocol for infection control was developed to potentially decrease infection rates. Further cost and efficacy data are warranted.
即刻乳房植入重建术在整形外科中感染发生率最高。文献检索得到的关键文章表明，通过术前用莫匹罗星鼻软膏对鼻腔进行拭子评估以治疗甲氧西林敏感和耐甲氧西林金黄色葡萄球菌，并对手术区域进行5天的氯己定擦洗，手术部位感染显著减少。其他一级数据支持在皮肤准备时使用氯己定-酒精而非聚维酮碘溶液。乳房腔隙冲洗的术中数据显示了聚维酮碘以及三联抗生素溶液的益处。对120例患者的鼻腔拭子检测显示，未发现耐甲氧西林金黄色葡萄球菌，但确实发现10例甲氧西林敏感金黄色葡萄球菌患者、1例链球菌患者和3例革兰氏阴性杆菌患者，这改变了围手术期抗生素管理。基于上述数据，制定了一项基于证据的感染控制方案，以潜在降低感染率。还需要进一步的成本和疗效数据。
