Kraenzlin Franca S, Saunders Heather, Aliu Oluseyi, Cooney Damon, Rosson Gedge D, Sacks Justin M, Broderick Kristen, Manahan Michele A
Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Maryland Department of Health, Infectious Disease Epidemiology & Outbreak Response Bureau, Baltimore, Maryland.
J Surg Oncol. 2019 Aug;120(2):142-147. doi: 10.1002/jso.25500. Epub 2019 May 18.
Infections following tissue expander (TE) placement are frequent complications in breast reconstruction. While breast surgery is a clean case, implant-based breast reconstruction has rates of infection up to 31%, decidedly higher than the typical 1% to 2% rate of surgical site infections (SSI). Few authors use the Center for Disease Control's (CDC) SSI definition for TE infections. We highlight how adoption of a consistent definition of TE infection may change how infections are researched, categorized, and ultimately managed.
Two researchers with definitional discrepancies of infection performed an independent analysis of all postmastectomy patients receiving TEs (n = 175) in 2017.
Researcher One, using a clinical definition, delineated an infection rate of 19.4%. Antibiotics alone successfully treated 50% of cases. Researcher Two found an infection rate of 13.7% using CDC criteria. These infections were further delineated by a SSI rate of 6.3% and a TE infection rate post port access of 7.4%. Only 45.5% SSI's and 15.4% of TE infections were salvaged with antibiotics alone.
Rigorous adoption of CDC criteria for infection characterization in published research will help standardize the definition of infection and allow surgeons to create evidence-based infection prevention regimens.
组织扩张器（TE）置入后的感染是乳房重建中常见的并发症。虽然乳房手术属于清洁手术，但基于植入物的乳房重建感染率高达31%，明显高于典型的手术部位感染（SSI）1%至2%的发生率。很少有作者采用疾病控制中心（CDC）的SSI定义来界定TE感染。我们强调采用一致的TE感染定义可能会改变感染的研究、分类以及最终的管理方式。
两名对感染定义存在差异的研究人员对2017年所有接受TE的乳房切除术后患者（n = 175）进行了独立分析。
研究人员一采用临床定义，得出感染率为19.4%。仅使用抗生素成功治疗了50%的病例。研究人员二采用CDC标准，发现感染率为13.7%。这些感染进一步细分为SSI率6.3%和端口接入后TE感染率7.4%。仅使用抗生素挽救了45.5%的SSI和15.4%的TE感染。
在已发表研究中严格采用CDC标准进行感染特征描述，将有助于规范感染定义，并使外科医生能够制定基于证据的感染预防方案。
