Rubino Corrado, Brongo Sergio, Pagliara Domenico, Cuomo Roberto, Abbinante Giulia, Campitiello Nicola, Santanelli Fabio, Chessa Daniela
Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy.
J Infect Dev Ctries. 2014 Sep 12;8(9):1089-95. doi: 10.3855/jidc.3898.
The risk of surgical site infection is always present in surgery; the use of prosthetic materials is linked to an increased possibility of infection. Breast augmentation and breast reconstruction with implants are gaining popularity in developing countries. Implant infection is the main complication related to breast aesthetic and reconstructive surgery. In the present paper, we reviewed the current microbiological knowledge about implant infections, with particular attention to risk factors, diagnosis, clinical management, and antibiotic prophylaxis, focusing on reports from developing countries. After breast aesthetic surgery, up to 2.9% of patients develop a surgical site infection, with an incidence of 1.7% for acute infections and 0.8% for late infections. The rate of surgical site infection after post-mastectomy breast reconstruction is usually higher, ranging from 1% to 53%. The clinical features are not constant, and bacterial culture with antibiogram is the gold standard for diagnosis and for identification of antibiotic resistance. While waiting for culture results, empiric therapy with vancomycin and extended-spectrum penicillins or cephalosporins is recommended. Some patients require removal of the infected prosthesis. The main methods to bring down the risk of infection are strict asepsis protocol, preoperative antibiotic prophylaxis, and irrigation of the surgical pocket and implant with an antibiotic solution.
手术部位感染的风险在手术中始终存在；使用假体材料会增加感染的可能性。在发展中国家，植入式隆胸和乳房重建越来越普遍。植入物感染是与乳房美容和重建手术相关的主要并发症。在本文中，我们回顾了目前关于植入物感染的微生物学知识，特别关注风险因素、诊断、临床管理和抗生素预防，重点关注来自发展中国家的报告。乳房美容手术后，高达2.9%的患者会发生手术部位感染，急性感染的发生率为1.7%，晚期感染的发生率为0.8%。乳房切除术后乳房重建后的手术部位感染率通常更高，范围为1%至53%。临床特征并不恒定，细菌培养及药敏试验是诊断和鉴定抗生素耐药性的金标准。在等待培养结果期间，建议使用万古霉素和广谱青霉素或头孢菌素进行经验性治疗。一些患者需要取出感染的假体。降低感染风险的主要方法是严格的无菌操作规范、术前抗生素预防以及用抗生素溶液冲洗手术腔隙和植入物。
