Phillips Brett T, Bishawi Muath, Dagum Alexander B, Bui Duc T, Khan Sami U
Division of Plastic, Maxillofacial, & Oral Surgery, Duke University Medical Center, Durham, NC.
Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC.
Eplasty. 2014 Nov 11;14:e42. eCollection 2014.
Reported infection rates in breast reconstruction with acellular dermal matrix (ADM) can exceed 31%. Prophylactic antibiotics remain controversial due to the absence of evidence-based literature. The purpose of this study was to examine published antibiotic regimens and their associated infection rates in this population.
Systematic electronic searches were performed in PubMed, OVID, and the Cochrane databases for studies that reported on prophylactic antibiotic use and infection in patients undergoing ADM breast reconstruction. Two independent authors reviewed studies between 1970 and 2012 for inclusion and data extraction.
A total of 863 studies were identified and abstracts reviewed. A total of 24 articles were included, with 2148 patients and 3189 ADM reconstructions. Mean infection rates varied between 0% and 31.25%, with a combined average of 11.59%. When comparing antibiotic protocols of less than 24 hours and more than 24 hours, the average infection rate was 2.48% and 13.21%, respectively.
The current literature lacks consensus on the necessary duration for postoperative antibiotic prophylaxis following breast reconstruction. The potential increased risk of infection associated with ADM remains controversial. Because of the lack of supportive evidence, we do not recommend prolonged postoperative antibiotics in ADM breast reconstruction.
Therapeutic level III evidence.
据报道，使用脱细胞真皮基质（ADM）进行乳房重建的感染率可能超过31%。由于缺乏循证文献，预防性使用抗生素仍存在争议。本研究的目的是调查已发表的抗生素治疗方案及其在该人群中的相关感染率。
在PubMed、OVID和Cochrane数据库中进行系统的电子检索，以查找关于接受ADM乳房重建患者预防性使用抗生素和感染情况的研究。两位独立作者对1970年至2012年期间的研究进行了纳入和数据提取审查。
共识别出863项研究并审查了摘要。共纳入24篇文章，涉及2148例患者和3189次ADM重建。平均感染率在0%至31.25%之间，综合平均为11.59%。比较使用抗生素时间少于24小时和多于24小时的方案时，平均感染率分别为2.48%和13.21%。
目前的文献对于乳房重建术后预防性使用抗生素的必要时长缺乏共识。与ADM相关的潜在感染风险增加仍存在争议。由于缺乏支持性证据，我们不建议在ADM乳房重建中延长术后抗生素使用时间。
治疗性III级证据。
