Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California, USA.
Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
J Surg Oncol. 2021 Oct;124(5):722-730. doi: 10.1002/jso.26599. Epub 2021 Jul 8.
Staged implant-based breast reconstruction is the most common reconstructive modality following mastectomy. Postoperative implant infections can have a significant impact on adjuvant oncologic care and reconstructive outcome. Here, we investigate the impact of β-lactam antibiotics (i.e., bactericidal) compared to alternative antibiotic agents on postoperative outcomes for implant-based breast reconstruction.
A retrospective analysis of patients who underwent immediate sub-pectoral tissue expander placement with an inferior acellular dermal matrix (ADM) sling at a single institution between May 2008 and July 2018 was performed. Patient demographics, comorbidities, and complication rates were retrieved. The impact of antibiotic regimen on postoperative outcomes, including infection rate and reconstructive failure, was investigated.
A total of 320 patients with a mean age and BMI of 48.2 years and 25.0 kg/m , respectively, who underwent 542 immediate breast reconstructions were included in the study. The use of a β-lactam antibiotic was protective against postoperative infection (odds ratio [OR] = 0.467, p = .046), infection requiring operative management (OR = 0.313, p = .022), and reconstructive failure (OR = 0.365, p = .028). Extended, that is, post-discharge, prophylaxis was not associated with any clinical benefit.
The use of β-lactam antibiotics for pre-/peri-operative prophylaxis is superior to alternative antibiotics with a bacteriostatic mechanism of action regarding rates of postoperative infection and reconstructive failure following immediate tissue expander-based breast reconstruction. Extended, that is, post-discharge, prophylaxis does not appear to be indicated, regardless of the antibiotic chosen.
分期植入物乳房重建是乳房切除术后最常见的重建方式。术后植入物感染会对辅助肿瘤治疗和重建结果产生重大影响。在这里，我们研究了β-内酰胺类抗生素（即杀菌性）与替代抗生素药物对基于植入物的乳房重建术后结果的影响。
对 2008 年 5 月至 2018 年 7 月在一家机构接受即刻胸下组织扩张器放置并带有下外侧脱细胞真皮基质（ADM）吊带的患者进行了回顾性分析。检索患者的人口统计学、合并症和并发症发生率。研究了抗生素方案对术后结果的影响，包括感染率和重建失败率。
共有 320 名平均年龄和 BMI 分别为 48.2 岁和 25.0kg/m 的患者接受了 542 例即刻乳房重建术。β-内酰胺类抗生素的使用可预防术后感染（优势比 [OR] = 0.467，p = 0.046）、需要手术治疗的感染（OR = 0.313，p = 0.022）和重建失败（OR = 0.365，p = 0.028）。延长，即出院后，预防措施并没有带来任何临床益处。
与具有抑菌作用机制的替代抗生素相比，在即刻组织扩张器乳房重建术后，使用β-内酰胺类抗生素进行术前/围手术期预防可降低术后感染和重建失败的发生率。延长，即出院后，无论选择何种抗生素，预防似乎都没有必要。
