Phillips Brett T, Halvorson Eric G
Durham, N.C.; and Boston, Mass.
From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and the Division of Plastic Surgery, Brigham & Women's Hospital, Harvard Medical School.
Plast Reconstr Surg. 2016 Oct;138(4):751-757. doi: 10.1097/PRS.0000000000002530.
Although data from other surgical disciplines do not support the use of prolonged postoperative prophylactic antibiotics, implant-based breast reconstruction is one area of plastic surgery where this may be warranted. The purpose of this study was to review the literature on antibiotic prophylaxis in prosthetic breast reconstruction, summarize findings, and provide recommendations.
A literature review was performed to identify studies that compared different perioperative prophylactic antibiotic regimens with respect to infectious outcomes in prosthetic breast reconstruction.
Five studies and five systematic reviews were identified. One prospective randomized trial showed that a single preoperative dose was better than placebo, and another showed no difference between 24 hours versus until drain removal. Three studies were retrospective, one showing no difference between a single preoperative dose and prolonged antibiotic use, and two showing significant reduction in infectious complications with prolonged antibiotic use. One systematic review suggested an increased rate of infection with prolonged antibiotic use, and the other showed no difference between less than 24 hours and greater than 24 hours, but showed a reduction in infections compared to no treatment.
The literature contains conflicting data regarding the optimal duration for perioperative antibiotic prophylaxis following prosthetic breast reconstruction. The authors' opinion is that 24 hours of antibiotic prophylaxis is warranted. Further studies are needed. Patient-centered antibiotic prophylaxis based on a risk-assessment model may be a more effective alternative to the current indiscriminate model of surgical-site infection control.
尽管其他外科领域的数据不支持长期使用术后预防性抗生素，但基于植入物的乳房重建是整形外科中可能需要这样做的一个领域。本研究的目的是回顾有关假体乳房重建中抗生素预防的文献，总结研究结果并提供建议。
进行文献综述，以确定比较不同围手术期预防性抗生素方案在假体乳房重建中感染结局的研究。
共确定了五项研究和五项系统评价。一项前瞻性随机试验表明，术前单次给药优于安慰剂，另一项试验表明24小时给药与引流管拔除前给药之间无差异。三项研究为回顾性研究，一项研究表明术前单次给药与长期使用抗生素之间无差异，两项研究表明长期使用抗生素可显著降低感染并发症。一项系统评价表明长期使用抗生素会增加感染率，另一项系统评价表明少于24小时给药与多于24小时给药之间无差异，但与未治疗相比感染率有所降低。
关于假体乳房重建后围手术期抗生素预防的最佳持续时间，文献中的数据相互矛盾。作者认为有必要进行24小时的抗生素预防。还需要进一步的研究。基于风险评估模型的以患者为中心的抗生素预防可能是当前不加区分的手术部位感染控制模式的更有效替代方案。
