McCullough Meghan C, Chu Carrie K, Duggal Claire S, Losken Albert, Carlson Grant W
From the Division of Plastic Surgery, Emory University School of Medicine, Atlanta,GA.
Ann Plast Surg. 2016 Nov;77(5):501-505. doi: 10.1097/SAP.0000000000000275.
A recent survey of plastic surgeons showed that the majority prescribed prophylactic antibiotics after hospital discharge for breast reconstruction. There is no clinical evidence that this practice reduces surgical site infection (SSI) after immediate tissue expander breast reconstruction. Furthermore, multiple studies have suggested that current antibiotic choices may not be appropriately covering the causative organisms of SSI.
An institutional breast reconstruction database from January 2005 to December 2011 was queried to identify patients undergoing immediate tissue expander reconstruction of the breast. The bacteriology of the infection, prophylactic and empiric antibiotic use, and antibiotic sensitivities were analyzed.
In 557 cases of immediate tissue expander breast reconstruction performed in 378 patients, SSIs were diagnosed in 50 (9.0%) cases. Two hundred patients were given oral antibiotics at discharge; 178 did not receive antibiotics. Surgical site infection developed in 12.0% of patients given oral antibiotics and in 13.5% of those not receiving antibiotics (P = 0.67). Wound culture data were obtained in 34 SSIs. Twenty-nine had positive cultures. The most common offending organisms were methicillin-sensitive (11) and methicillin-resistant (6) Staphylococcus aureus. Despite increased use of postoperative prophylaxis over the years, SSI incidence remained unchanged. However, trends toward increased resistance of SSI organisms to the preoperative and postoperative prophylaxis agents were observed. When first-generation cephalosporins were used as prophylaxis, SSI organisms showed resistance rates of 20.5% (preoperative cefazolin) and 54.5% (postoperative cephalexin).
Administration of extended prophylactic antibiotics does not reduce overall risk of SSI after expander-based breast reconstruction but may influence antibiotic resistance patterns when infections occur. The organisms most commonly responsible for SSI are often resistant to cefazolin.
最近一项针对整形外科医生的调查显示，大多数医生在乳房重建术后出院时会开具预防性抗生素。目前尚无临床证据表明这种做法能降低即刻组织扩张器乳房重建术后的手术部位感染（SSI）发生率。此外，多项研究表明，目前选择的抗生素可能无法有效覆盖SSI的致病微生物。
查询了一个机构2005年1月至2011年12月的乳房重建数据库，以确定接受即刻组织扩张器乳房重建的患者。分析了感染的细菌学、预防性和经验性抗生素的使用情况以及抗生素敏感性。
在378例患者中进行的557例即刻组织扩张器乳房重建手术中，有50例（9.0%）被诊断为SSI。200例患者在出院时接受了口服抗生素治疗；178例未接受抗生素治疗。接受口服抗生素治疗的患者中12.0%发生了手术部位感染，未接受抗生素治疗的患者中这一比例为13.5%（P = 0.67）。在34例SSI病例中获取了伤口培养数据。29例培养结果呈阳性。最常见的致病微生物是甲氧西林敏感（11例）和甲氧西林耐药（6例）金黄色葡萄球菌。尽管多年来术后预防性用药有所增加，但SSI发生率仍未改变。然而，观察到SSI病原体对术前和术后预防用药的耐药性有增加趋势。当使用第一代头孢菌素作为预防用药时，SSI病原体对术前头孢唑林的耐药率为20.5%，对术后头孢氨苄的耐药率为54.5%。
延长预防性抗生素的使用并不能降低基于扩张器的乳房重建术后SSI的总体风险，但在发生感染时可能会影响抗生素耐药模式。导致SSI最常见的病原体通常对头孢唑林耐药。
