From the Departments of Plastic Surgery and Burns Treatment.
Department of Plastic and Reconstructive Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital.
Plast Reconstr Surg. 2024 Jul 1;154(1):5-13. doi: 10.1097/PRS.0000000000010869. Epub 2023 Jun 20.
Antibiotic implant irrigation is increasingly used to prevent deep infection after implant-based breast reconstruction. However, there is limited evidence of the clinical effect. In this study, the authors compare the risk of a deep infection in a Danish population of women who received antibiotic implant irrigation with either gentamicin or vancomycin, or no irrigation.
The authors retrospectively reviewed consecutive patients undergoing all types of breast reconstruction with implants at Rigshospitalet and Herlev Hospital, Denmark, from 2010 to 2019. Logistic regression was used to compare the risk of deep infection between no irrigation and irrigation with gentamicin or vancomycin, and to account for the difference in risk between patient subgroups and risk factors.
The authors included 1508 patients who received antibiotic irrigation with gentamicin (500 patients), vancomycin (304 patients), or no irrigation (704 patients). The univariable risk analysis showed a significant decreased risk of deep infection using gentamicin irrigation compared with no irrigation (OR, 0.58; P < 0.05). However, when adjusting for risk factors for infection, there was no significant decrease in the risk of infection when using gentamicin (OR, 0.90; P = 0.71) or vancomycin (OR, 1.0; P = 0.99) compared with the control group.
The authors found no significant effect of using antibiotic implant irrigation after isolating it from risk factors for deep infection. However, because of the limitations of the study, the authors cannot conclude that there is no effect of antibiotic implant irrigation. There is a need for a randomized, placebo-controlled trial to investigate the effect, and potential side-effects, of antibiotic implant irrigation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
抗生素植入物冲洗越来越多地用于预防基于植入物的乳房重建后深部感染。然而，关于其临床效果的证据有限。在这项研究中，作者比较了丹麦女性人群中接受庆大霉素或万古霉素或不冲洗的抗生素植入物冲洗的深部感染风险。
作者回顾性分析了 2010 年至 2019 年在丹麦里希斯医院和赫勒勒医院接受各种类型植入物乳房重建的连续患者。使用逻辑回归比较不冲洗和用庆大霉素或万古霉素冲洗的深部感染风险，并考虑患者亚组和风险因素之间的风险差异。
作者纳入了 1508 名接受庆大霉素（500 名患者）、万古霉素（304 名患者）或不冲洗（704 名患者）抗生素冲洗的患者。单变量风险分析显示，与不冲洗相比，使用庆大霉素冲洗可显著降低深部感染的风险（OR，0.58；P < 0.05）。然而，在调整感染风险因素后，与对照组相比，使用庆大霉素（OR，0.90；P = 0.71）或万古霉素（OR，1.0；P = 0.99）冲洗并未显著降低感染风险。
作者发现将抗生素植入物冲洗从深部感染的风险因素中分离出来后，没有显著效果。然而，由于研究的局限性，作者无法得出抗生素植入物冲洗没有效果的结论。需要进行随机、安慰剂对照试验来研究抗生素植入物冲洗的效果和潜在的副作用。
临床问题/证据水平：风险，II 级。
