乳房切除术和乳房重建术后的出院后预防性抗生素。
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
机构信息
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri.
Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri.
出版信息
Infect Control Hosp Epidemiol. 2022 Oct;43(10):1382-1388. doi: 10.1017/ice.2021.400. Epub 2021 Sep 27.
BACKGROUND
Prophylactic antibiotics are commonly prescribed at discharge for mastectomy, despite guidelines recommending against this practice. We investigated factors associated with postdischarge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI).
STUDY DESIGN
We studied a cohort of women aged 18-64 years undergoing mastectomy between January 1, 2010, and June 30, 2015, using the MarketScan commercial database. Patients with nonsurgical perioperative infections were excluded. Postdischarge oral antibiotics were identified from outpatient drug claims. SSI was defined using (ICD-9-CM) diagnosis codes. Generalized linear models were used to determine factors associated with postdischarge prophylactic antibiotic use and SSI.
RESULTS
The cohort included 38,793 procedures; 24,818 (64%) with immediate reconstruction. Prophylactic antibiotics were prescribed after discharge after 2,688 mastectomy-only procedures (19.2%) and 17,807 mastectomies with immediate reconstruction (71.8%). The 90-day incidence of SSI was 3.5% after mastectomy only and 8.8% after mastectomy with immediate reconstruction. Antibiotics with anti-methicillin-sensitive (MSSA) activity were associated with decreased SSI risk after mastectomy only (adjusted relative risk [aRR], 0.74; 95% confidence interval [CI], 0.55-0.99) and mastectomy with immediate reconstruction (aRR, 0.80; 95% CI, 0.73-0.88), respectively. The numbers needed to treat to prevent 1 additional SSI were 107 and 48, respectively.
CONCLUSIONS
Postdischarge prophylactic antibiotics were common after mastectomy. Anti-MSSA antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. The high numbers needed to treat suggest that potential benefits of postdischarge antibiotics should be weighed against potential harms associated with antibiotic overuse.
背景
尽管指南建议不要这样做，但预防性抗生素仍常被开具用于乳房切除术的出院后治疗。我们研究了乳房切除术（伴或不伴即刻重建）后预防性使用抗生素的相关因素及其对手术部位感染（SSI）的影响。
研究设计
我们使用 MarketScan 商业数据库研究了 2010 年 1 月 1 日至 2015 年 6 月 30 日期间接受乳房切除术的 18-64 岁女性队列。排除围手术期无手术相关感染的患者。出院后口服抗生素从门诊药物索赔中确定。SSI 使用（ICD-9-CM）诊断代码定义。使用广义线性模型确定与出院后预防性使用抗生素和 SSI 相关的因素。
结果
该队列包括 38793 例手术；其中 24818 例（64%）即刻重建。仅乳房切除术 2688 例（19.2%）和即刻重建乳房切除术 17807 例（71.8%）后开具了预防性抗生素出院。仅乳房切除术和即刻重建乳房切除术的 90 天 SSI 发生率分别为 3.5%和 8.8%。对甲氧西林敏感金黄色葡萄球菌（MSSA）有活性的抗生素与仅乳房切除术（调整后的相对风险 [aRR]，0.74；95%置信区间 [CI]，0.55-0.99）和即刻重建乳房切除术（aRR，0.80；95% CI，0.73-0.88）后的 SSI 风险降低相关。预防 1 例 SSI 的需要治疗人数分别为 107 和 48。
结论
乳房切除术后，预防性抗生素出院后使用普遍。对甲氧西林敏感金黄色葡萄球菌（MSSA）有活性的抗生素与仅乳房切除术和即刻重建乳房切除术的患者 SSI 风险降低相关。需要治疗的人数较多表明，应权衡预防性抗生素的潜在益处与抗生素过度使用相关的潜在危害。
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