Sisco Mark, Kuchta Kristine, Alva Duanny, Seth Akhil K
From the Department of Surgery, Division of Plastic Surgery.
Biostatistical Core, NorthShore University HealthSystem Research Institute.
Plast Reconstr Surg. 2023 May 1;151(5):730e-738e. doi: 10.1097/PRS.0000000000010073. Epub 2022 Dec 19.
Infectious complications following implant-based postmastectomy breast reconstruction (PMBR) are a significant cause of morbidity. Nationwide, antimicrobial stewardship efforts have sought to reduce the use of prophylactic antibiotics postoperatively. However, there are conflicting data regarding the utility of extended antibiotic prophylaxis (EAP) after PMBR, and many surgeons continue to prescribe them.
The authors conducted a retrospective study of 1077 women who underwent immediate prosthetic PMBR from January of 2008 to May of 2020. All patients received intravenous antibiotics preoperatively and up to 24 hours postoperatively. Before October of 2016, patients were also prescribed oral antibiotics until drain removal; thereafter, this practice was abandoned. Ninety-day outcomes were compared between EAP-positive and EAP-negative patients. Descriptive statistics and multivariable logistic regression analysis were used to assess the efficacy of EAP in preventing infection-related complications.
There were 1004 breasts in the EAP-positive group and 683 in the EAP-negative group. Three hundred sixty-one reconstructions (21.4%) were prepectoral. Multivariable analysis demonstrated no difference in surgical-site infection (OR, 0.83; 95% CI, 0.56 to 1.25; P = 0.38), admission (OR, 0.78; 95% CI, 0.41 to 1.48; P = 0.44), reoperation (OR, 1.01; 95% CI, 0.68 to 1.48; P = 0.97), or explantation rates (OR, 1.06; 95% CI, 0.66 to 1.71; P = 0.81) between the EAP groups. The EAP-positive group was more likely to develop Gram-negative infections ( P < 0.001). Thirteen EAP-positive women (2.0%) developed allergic reactions, and four (0.6%) developed Clostridium difficile colitis attributable to the EAP.
EAP after PMBR did not improve outcomes. Although use of EAP did not appear to worsen clinical outcomes, marked differences in the microbiology of associated infections may render them more difficult to treat. Moreover, a small but significant proportion of women experienced adverse reactions to the EAP.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
基于植入物的乳房切除术后乳房重建（PMBR）后的感染并发症是发病的重要原因。在全国范围内，抗菌管理工作一直在努力减少术后预防性抗生素的使用。然而，关于PMBR后延长抗生素预防（EAP）的效用存在相互矛盾的数据，许多外科医生仍继续开具此类药物。
作者对2008年1月至2020年5月期间接受即刻假体PMBR的1077名女性进行了一项回顾性研究。所有患者术前及术后24小时内接受静脉抗生素治疗。2016年10月之前，患者还会被开具口服抗生素直至引流管拔除；此后，这种做法被摒弃。对EAP阳性和EAP阴性患者的90天结局进行比较。采用描述性统计和多变量逻辑回归分析来评估EAP预防感染相关并发症的疗效。
EAP阳性组有1004个乳房，EAP阴性组有683个乳房。361例重建手术（21.4%）为胸肌前重建。多变量分析显示，EAP组之间在手术部位感染（比值比[OR]，0.83；95%置信区间[CI]，0.56至1.25；P = 0.38）、住院（OR，0.78；95% CI，0.41至1.48；P = 0.44）、再次手术（OR，1.01；95% CI，0.68至1.48；P = 0.97）或取出植入物率（OR，1.06；95% CI，0.66至1.71；P = 0.81）方面无差异。EAP阳性组更易发生革兰氏阴性菌感染（P < 0.001）。13名EAP阳性女性（2.0%）出现过敏反应，4名（0.6%）因EAP发生艰难梭菌结肠炎。
PMBR后的EAP并未改善结局。虽然使用EAP似乎并未使临床结局恶化，但相关感染微生物学的显著差异可能使其更难治疗。此外，一小部分但比例显著的女性对EAP有不良反应。
临床问题/证据级别：治疗性，III级
