围手术期预防性使用抗生素的时间是否会影响乳腺癌女性假体乳房再造术后手术部位感染的发生率？一项回顾性研究。
Does the Duration of Perioperative Antibiotic Prophylaxis Influence the Incidence of Postoperative Surgical-Site Infections in Implant-Based Breast Reconstruction in Women with Breast Cancer? A Retrospective Study.
机构信息
From the Institute for Medical Microbiology, Immunology, and Hygiene, Department of Obstetrics and Gynecology, Institute of Medical Informatics, Statistics, and Epidemiology, and Hospital Pharmacy, Technical University of Munich, School of Medicine; and Hospital Pharmacy, Klinikum Starnberg GmbH, Academic Teaching Hospital of the Ludwig-Maximilians-Universität München.
出版信息
Plast Reconstr Surg. 2022 Apr 1;149(4):617e-628e. doi: 10.1097/PRS.0000000000008900.
BACKGROUND
Perioperative antibiotic prophylaxis is an established concept to reduce the risk of surgical-site infections; however, the optimal treatment duration in prosthetic breast reconstruction is still controversial. This study evaluated a potential association between the perioperative antibiotic prophylaxis duration (≤24 hours versus >24 hours) and incidence of postoperative surgical-site infections in immediate implant-based breast reconstruction in breast cancer patients.
METHODS
A descriptive, retrospective analysis of surgical-site infections after immediate implant-based breast reconstruction in breast cancer patients between January of 2011 and December of 2018 was performed. The incidence of postoperative surgical-site infections in patients with more than 24 hours of perioperative antibiotic prophylaxis was compared to patients treated for 24 hours or less.
RESULTS
A total of 240 patients who met criteria were included. There were no relevant epidemiologic, clinical, or histopathologic differences between groups. Surgical-site infections as defined by the Centers for Disease Control and Prevention criteria occurred in 25.8 percent. A risk factor-adjusted analysis by a prespecified multiple logistic regression model showed that 24 hours or less of perioperative antibiotic prophylaxis was not inferior to treatment for more than 24 hours. The upper limit of the one-sided 95 percent confidence interval of the risk difference was 9.4 percent (below the prespecified noninferiority margin of 10 percent leading to statistical significance). Risk factors for a surgical-site infection included obesity and postoperative wound complications.
CONCLUSIONS
The study found no association between short-course perioperative antibiotic prophylaxis (≤24 hours) and an increased rate of postoperative surgical-site infection. This is of high clinical relevance because short-course treatment can help reduce side effects and the emergence of antimicrobial resistance and prevent surgical-site infections as effectively as a prolonged perioperative antibiotic prophylaxis course.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
围手术期抗生素预防是降低手术部位感染风险的既定概念；然而，在假体乳房重建中，最佳的治疗持续时间仍存在争议。本研究评估了围手术期抗生素预防持续时间（≤24 小时与>24 小时）与乳腺癌患者即刻假体乳房重建后术后手术部位感染发生率之间的潜在关联。
方法
对 2011 年 1 月至 2018 年 12 月间行即刻假体乳房重建的乳腺癌患者的术后手术部位感染进行描述性、回顾性分析。将接受超过 24 小时围手术期抗生素预防的患者与接受 24 小时或更短时间治疗的患者的术后手术部位感染发生率进行比较。
结果
共有 240 例符合条件的患者被纳入研究。两组患者在流行病学、临床或组织病理学方面均无显著差异。根据疾病控制和预防中心的标准，定义的手术部位感染发生率为 25.8%。通过预设的多变量逻辑回归模型进行风险因素调整分析显示，24 小时或更短的围手术期抗生素预防并不逊于 24 小时以上的治疗。风险差异单侧 95%置信区间的上限为 9.4%（低于预设的非劣效性边界 10%，具有统计学意义）。手术部位感染的风险因素包括肥胖和术后伤口并发症。
结论
本研究未发现短疗程（≤24 小时）围手术期抗生素预防与术后手术部位感染发生率增加之间存在关联。这具有重要的临床意义，因为短疗程治疗可以帮助减少副作用和抗生素耐药性的出现，并能像延长围手术期抗生素预防疗程一样有效地预防手术部位感染。
临床问题/证据水平：治疗性，III 级。
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