Hai Yang, Chong Weelic, Lazar Melissa A
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa.
Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pa.
Plast Reconstr Surg Glob Open. 2020 Jan 27;8(1):e2613. doi: 10.1097/GOX.0000000000002613. eCollection 2020 Jan.
The risk of surgical site infection (SSI) for breast surgery in patients without additional risk factors is low, below 5%. Evidence shows the risk of SSI is significantly elevated in patients undergoing immediate breast reconstruction (IBR). However, there is no consensus regarding the use of extended antibiotic prophylaxis. We aim to determine the effect of extended antibiotic prophylaxis on the incidence of SSI after IBR.
PubMed and Scopus were searched by 2 independent reviewers. Data abstracted included types of study, basic characteristics, detailed antibiotic prophylaxis information, SSI event, and other secondary outcomes. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study and used a random-effects model to estimate the results. Study quality, bias, and heterogeneity were also analyzed.
A total of 11 studies (15,966 mastectomy procedures) were included. We found an overall 5.99% SSI rate in our population. Three studies comparing topical antibiotics with no topical antibiotics demonstrated statistical significance (RR = 0.26, 95% CI: 0.12-0.60, = 0.001), whereas 8 studies comparing extended systemic antibiotics with standard of care found no statistical significance (RR = 0.80, 95% CI: 0.60-1.08, = 0.13).
In the setting of IBR following mastectomy, there is insufficient evidence for the use of extended prophylactic antibiotics to reduce SSI rates. Well-designed randomized controlled trials in patients undergoing IBR should be conducted to determine the appropriate regimen and/or duration of prophylactic antibiotics on SSI outcomes.
对于没有其他危险因素的患者，乳房手术的手术部位感染（SSI）风险较低，低于5%。有证据表明，即刻乳房重建（IBR）患者的SSI风险显著升高。然而，对于延长抗生素预防的使用尚无共识。我们旨在确定延长抗生素预防对IBR后SSI发生率的影响。
由2名独立评审员检索PubMed和Scopus。提取的数据包括研究类型、基本特征、详细的抗生素预防信息、SSI事件和其他次要结局。我们计算了每项研究的风险比（RR）和95%置信区间（CI），并使用随机效应模型估计结果。还分析了研究质量、偏倚和异质性。
共纳入11项研究（15966例乳房切除术）。我们发现总体人群的SSI发生率为5.99%。三项比较局部使用抗生素与不使用局部抗生素的研究显示出统计学意义（RR = 0.26，95% CI：0.12 - 0.60，P = 0.001），而八项比较延长全身性抗生素与标准治疗的研究未发现统计学意义（RR = 0.80，95% CI：0.60 - 1.08，P = 0.13）。
在乳房切除术后进行IBR的情况下，没有足够的证据支持使用延长预防性抗生素来降低SSI发生率。应针对IBR患者开展设计良好的随机对照试验，以确定预防性抗生素的合适方案和/或疗程对SSI结局的影响。
