Graziano Francis D, Shammas Ronnie L, Mehrara Babak J, Rochlin Danielle H
From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Ann Plast Surg. 2025 May 30. doi: 10.1097/SAP.0000000000004416.
Infection is a major complication of implant-based breast reconstruction (IBBR), leading to implant loss, increased healthcare costs, and poor outcomes. Local antibiotic delivery systems offer targeted infection prevention by providing sustained antibiotic release at the surgical site. The aim of this study is to review the existing literature on the efficacy of local antibiotic delivery systems in preventing infection in IBBR.
A systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted in Medline, Cochrane, and Embase (1990-2025). Studies assessing local antibiotic delivery in IBBR were included, while those evaluating systemic antibiotics, augmentation, and salvage procedures were excluded. Data on infection rates, implant loss, and complications were extracted and analyzed.
Of 163 identified articles, 6 met inclusion criteria. Two studies examined calcium sulfate biodegradable antibiotic beads, which significantly lower implant loss rates (1.6% vs 9.4%, P = 0.031 and 1.5% vs 11.9%, P = 0.024). Two studies on polymethylmethacrylate antibiotic plates showed significant SSI reduction from 12.6% to 4.8% (P < 0.01) and from 14% to 4% (P = 0.047), with implant loss rates significantly lower in polymethylmethacrylate cohort (6% vs 18%, P = 0.036). Continuous postoperative antibiotic irrigation studies demonstrated SSI reduction from 6.4% to 1.9% (P = 0.007) and decreased explant rate from 20% to 2.9% (P = 0.037), but one study reported a higher seroma rate (4.7% vs 1.4%, P = 0.033).
Preliminary studies suggest local antibiotic delivery may reduce infection and implant loss in breast reconstruction, but retrospective designs and methodological limitations preclude definitive conclusions. Prospective studies are needed to confirm efficacy, safety, and clinical value.
感染是基于植入物的乳房重建术（IBBR）的主要并发症，可导致植入物丢失、医疗成本增加及预后不良。局部抗生素递送系统通过在手术部位持续释放抗生素来提供针对性的感染预防。本研究的目的是回顾关于局部抗生素递送系统在预防IBBR感染方面疗效的现有文献。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，在Medline、Cochrane和Embase数据库（1990 - 2025年）中进行系统评价。纳入评估IBBR中局部抗生素递送的研究，排除评估全身用抗生素、隆乳术和挽救手术的研究。提取并分析感染率、植入物丢失和并发症的数据。
在163篇检索到的文章中，6篇符合纳入标准。两项研究检测了硫酸钙可生物降解抗生素珠，其显著降低了植入物丢失率（分别为1.6%对9.4%，P = 0.031；1.5%对11.9%，P = 0.024）。两项关于聚甲基丙烯酸甲酯抗生素板的研究显示手术部位感染显著降低，从12.6%降至4.8%（P < 0.01）以及从14%降至4%（P = 0.047），聚甲基丙烯酸甲酯组的植入物丢失率显著更低（6%对18%，P = 0.036）。术后持续抗生素冲洗的研究显示手术部位感染从6.4%降至1.9%（P = 0.007），取出率从20%降至2.9%（P = 0.037），但一项研究报告血清肿发生率更高（4.7%对1.4%，P = 0.033）。
初步研究表明局部抗生素递送可能降低乳房重建中的感染和植入物丢失，但回顾性设计和方法学局限性妨碍得出确定性结论。需要进行前瞻性研究以确认其疗效、安全性和临床价值。
