Klein Gabriel M, Phillips Brett T, Dagum Alexander B, Bui Duc T, Khan Sami U
From the *Division of Plastic Surgery, Department of Surgery Stony Brook University Medical Center, Stony Brook, NY; and †Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery Duke Medicine, Durham, NC.
Ann Plast Surg. 2017 Feb;78(2):149-152. doi: 10.1097/SAP.0000000000000847.
Postoperative infections following tissue expander-based breast reconstruction represent a significant threat to the reconstructive process. Studies have found the incidence to be as high as 29%. There has been abundant research into the risk factors associated with these infections, although very few studies have focused on the causative organisms. The purpose of this study was to investigate the bacterial flora associated with tissue expander infections after breast reconstruction.
A retrospective analysis of all patients who underwent tissue expander-based breast reconstruction at our institution between February 2010 and April 2013 was conducted. The medical records were reviewed for demographic information, medical history, operative technique, postoperative course, and culture results. Descriptive data analysis was then performed.
A total of 56 tissue expander infections were identified in 49 patients during the study period. 41.1% of the cultures grew gram-positive organisms, whereas 28.6% grew gram-negative species. The 2 most common organisms were Staphylococcus aureus (17.9%) and Staphylococcus epidermidis (14.3%). Pseudomonas aeruginosa was the most frequent gram-negative species and was also the third most frequent organism cultured (10.9%).
Due to the high rate of infection in breast reconstruction patients, adequate perioperative prophylaxis is necessary. The surgeon must also be prepared to treat patients who may return with infection postoperatively. Although the majority of our infections were secondary to normal skin flora, a significant proportion were caused by gram-negative species. Given these results, the empiric antibiotic of choice for postoperative infections should be reconsidered to cover for these various organisms.
基于组织扩张器的乳房重建术后感染对重建过程构成重大威胁。研究发现其发生率高达29%。虽然对与这些感染相关的危险因素已有大量研究，但很少有研究关注致病微生物。本研究的目的是调查乳房重建后与组织扩张器感染相关的细菌菌群。
对2010年2月至2013年4月在我院接受基于组织扩张器的乳房重建的所有患者进行回顾性分析。查阅病历以获取人口统计学信息、病史、手术技术、术后病程及培养结果。然后进行描述性数据分析。
在研究期间，49例患者中共发现56例组织扩张器感染。41.1%的培养物中生长出革兰氏阳性菌，而28.6%生长出革兰氏阴性菌。两种最常见的细菌是金黄色葡萄球菌（17.9%）和表皮葡萄球菌（14.3%）。铜绿假单胞菌是最常见的革兰氏阴性菌，也是培养出的第三常见细菌（10.9%）。
由于乳房重建患者的感染率较高，围手术期进行充分的预防是必要的。外科医生还必须准备好治疗术后可能因感染而复诊的患者。虽然我们的大多数感染继发于正常皮肤菌群，但相当一部分是由革兰氏阴性菌引起的。鉴于这些结果，应重新考虑术后感染经验性抗生素的选择，以覆盖这些不同的微生物。
