Antibiotic implant irrigation and deep infection: A retrospective study of 1508 patients undergoing breast reconstruction with implants

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Pharmacokinetics of Locally Applied Antibiotic Prophylaxis for Implant-Based Breast Reconstruction

“…As a result, the infected implants must be surgically removed, and attempts at reimplantation are often postponed for several months. The most common bacterial infections in implant-based breast reconstruction include Staphylococcus aureus (23%-35%), followed by other gram-positive bacteria, such as Staphylococcus epidermidis , Streptococcus species, Corynebacterium species, and Cutibacterium acnes . In addition, gram-negative bacteria, including Pseudomonas aeruginosa , Enterobacter cloacae , Escherichia coli , Klebsiella pneumoniae , and Proteus mirabilis , can cause implant infections .…”

“…The most common bacterial infections in implant-based breast reconstruction include Staphylococcus aureus (23%-35%), followed by other gram-positive bacteria, such as Staphylococcus epidermidis , Streptococcus species, Corynebacterium species, and Cutibacterium acnes . 12 , 13 , 14 , 15 In addition, gram-negative bacteria, including Pseudomonas aeruginosa , Enterobacter cloacae , Escherichia coli , Klebsiella pneumoniae , and Proteus mirabilis , can cause implant infections. 13 , 16 , 17 Moreover, drug-resistant bacteria are an increasing problem in implant surgery.…”