Department of Plastic, Reconstructive and Aesthetic Surgery, Agaplesion Diakonieklinikum Hamburg, Hohe Weide 17, 20259 Hamburg, Germany; Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany.
Department of Plastic, Reconstructive and Aesthetic Surgery, Agaplesion Diakonieklinikum Hamburg, Hohe Weide 17, 20259 Hamburg, Germany.
J Plast Reconstr Aesthet Surg. 2021 Jul;74(7):1486-1494. doi: 10.1016/j.bjps.2020.11.005. Epub 2020 Nov 20.
Periprosthetic infections are feared complications in esthetic and reconstructive breast surgery. The purpose of our study is to evaluate our institution's specific culture data and to identify most common organisms and suitable antibiotics for prophylaxis and first-line treatment. We evaluated all patients with a change or removal of breast implants from 01.01.2012 to 31.12.2017 retrospectively. Based on the medical records, the surgical indications were identified and specifically analyzed for signs of infection, reasons for primary and secondary surgery, and all available microbiological data of these interventions. A total of 666 implant removals or exchanges were performed in 431 patients. Microbiological smears were gathered from 291 patients (449 implants). Bacteria were cultured from 63 implants (56 patients). In six additional patients (ten implants), a periprosthetic infection was seen, without bacteria detection. Advanced capsular contracture correlated with a higher proportion of positive swabs (p<0.05). In 11.5% of smears, bacterial contamination was found despite absence of clinical signs of infection. Coagulase-negative staphylococci were the dominant pathogen in clinical inapparent infections, while Staphylococcus aureus was when there was clinical evidence of infection. All pathogens were sensitive to vancomycin. In the majority of cases, bacterial contamination was an incidental finding, which was more common in the presence of advanced capsular contracture. In our institution, cefuroxime and amoxicillin/clavulanic acid have been proven to be reasonable choices for prevention and treatment of periprosthetic infections. In the treatment of fulminant infections and for the prophylaxis during implant replacement due to advanced capsular contracture, vancomycin became our first choice.
假体周围感染是美容和重建乳房手术中令人担忧的并发症。我们的研究目的是评估我们机构的特定培养数据，并确定最常见的病原体和用于预防和一线治疗的合适抗生素。我们回顾性地评估了所有从 2012 年 1 月 1 日至 2017 年 12 月 31 日因更换或取出乳房植入物的患者。根据病历，确定了手术指征，并特别分析了感染迹象、初次和二次手术的原因，以及这些干预措施的所有可用微生物学数据。共有 431 名患者接受了 666 次植入物取出或更换。从 291 名患者（449 个植入物）中采集了微生物涂片。从 63 个植入物（56 名患者）中培养出细菌。在另外 6 名患者（10 个植入物）中，尽管没有检测到细菌，但发现了假体周围感染。高级包膜挛缩与阳性拭子的比例更高相关（p<0.05）。在 11.5%的涂片样本中，尽管没有感染的临床迹象，但发现了细菌污染。凝固酶阴性葡萄球菌是临床无症状感染的主要病原体，而金黄色葡萄球菌则是有临床感染证据时的病原体。所有病原体对万古霉素均敏感。在大多数情况下，细菌污染是偶然发现的，在高级包膜挛缩的情况下更为常见。在我们机构中，头孢呋辛和阿莫西林/克拉维酸已被证明是预防和治疗假体周围感染的合理选择。在治疗暴发性感染和由于高级包膜挛缩而进行植入物更换的预防中，万古霉素成为我们的首选。
