Stony Brook, N.Y. From the Division of Plastic and Reconstructive Surgery, Stony Brook University Medical Center, and the Stony Brook University School of Medicine.
Plast Reconstr Surg. 2013 Jan;131(1):1-13. doi: 10.1097/PRS.0b013e3182729c39.
The literature reports overall complication rates in breast reconstruction to be as high as 60 percent. Infection rates can exceed 20 percent, much higher than anticipated in clean elective surgery. There is no consensus among surgeons regarding the necessary duration of antibiotic prophylaxis, although the Centers for Disease Control and Prevention guidelines suggest only 24 hours. This systematic review examines antibiotic regimens and associated infection rates in breast reconstruction.
Systematic electronic searches were performed in the PubMed, Ovid, and Cochrane databases using Medical Subject Headings terms for studies reporting antibiotic use and infection in all forms of breast reconstruction. Studies between 1970 and 2011 were reviewed. Included publications were required to report an antibiotic protocol and infection rate.
A total of 834 abstracts were identified, 81 of which met inclusion criteria and were included in the review. The overall reported infection rates in the included studies varied between 0 and 29 percent (average, 5.8 percent). When comparing combined patient cohorts receiving no antibiotics, less than 24 hours, and greater than 24 hours, the average infection rates were 14.4, 5.8, and 5.8 percent, respectively.
There is no consensus on the necessary duration of antibiotic prophylaxis following breast reconstruction. No benefit was found in patients who received more than 24 hours of postoperative antibiotics. Standardized definitions for antibiotic regimens, unit of analysis reporting, and a new breast reconstruction surgical-site infection grading system are offered to improve standardized outcome documentation. Randomized controlled trials are warranted to best determine an optimal antibiotic regimen.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
文献报道乳房重建的总体并发症发生率高达 60%。感染率可超过 20%，远高于清洁择期手术的预期。尽管疾病控制和预防中心的指南建议仅使用 24 小时，但外科医生对抗生素预防的必要持续时间没有达成共识。本系统评价检查了乳房重建中的抗生素方案和相关感染率。
使用 PubMed、Ovid 和 Cochrane 数据库中的医学主题词进行系统电子检索，检索所有形式的乳房重建中报告抗生素使用和感染的研究。回顾了 1970 年至 2011 年的研究。纳入的出版物必须报告抗生素方案和感染率。
共确定了 834 篇摘要，其中 81 篇符合纳入标准并纳入了综述。纳入研究中的总体报告感染率在 0%至 29%之间（平均为 5.8%）。当比较接受无抗生素、少于 24 小时和多于 24 小时抗生素的联合患者队列时，平均感染率分别为 14.4%、5.8%和 5.8%。
对于乳房重建后抗生素预防的必要持续时间没有共识。接受超过 24 小时术后抗生素治疗的患者没有获益。提供了标准化的抗生素方案定义、分析报告单位以及新的乳房重建手术部位感染分级系统，以改善标准化结果的记录。需要进行随机对照试验，以确定最佳的抗生素方案。
临床问题/证据水平：治疗性，III 级。
