Antibiotic prophylaxis in breast cancer surgery. A randomized controlled trial

Abstract

Purpose To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. Methods This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. Results Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. Conclusion Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.

Evidence-Based Medicine: Systemic Perioperative Antibiotic Prophylaxis for Prevention of Surgical-Site Infections in Plastic and Reconstructive Surgery

“…Five summary-of-findings tables and five clinical summary tables were created corresponding to clinical sections of Plastic and Reconstructive Surgery (Breast, Cosmetic, Hand/Peripheral Nerve, Pediatric/Craniofacial, and Reconstructive sections). Of the 138 included RCTs, 18 were breast (Tables 2 and 3), 10–27 10 cosmetic (Tables 4 and 5), 28–37 21 hand/peripheral nerve (Tables 6 and 7), 38–58 61 pediatric/craniofacial (Tables 8 and 9), 16,59–118 and 41 reconstructive (Tables 10 and 11). 16,28,38–42,54–56,119–149 Forest plots are provided for all comparisons.…”

“…Preoperative antibiotics decrease SSI compared with placebo (RR, 0.66; 95% CI, 0.52 to 0.83; 2986 participants; 10 studies; I 2 = 0%; P < 0.001; high-certainty evidence). 16,18–21,23–27…”

“…Preoperative antibiotics decrease SSI compared with placebo (RR, 0.66; 95% CI, 0.52 to 0.83; 2986 participants; 10 studies; I 2 = 0%; P < 0.001; high-certainty evidence). 16,[18][19][20][21][23][24][25][26][27] Evidence: Supports only preoperative systemic antibiotics for drains <7 days. 16,[18][19][20][21][22][23][24][25][26][27] 1.4 Immediate Reconstruction 1.4.1 Tissue Expanders.…”

Preoperative antibiotic prophylaxis in mastectomy: A retrospective comparative analysis of 1413 patients with breast cancer

“…In addition, differences in local treatment protocols and especially in basic infection-control strategies may have an effect on the results. 31 In the previous literature on the subject, there are vast differences in hospitalization time (from median 1 19 –14 days 27 ) and patient demographics (mean BMI of 30 kg/m 2 ) 19 to median weight of the patients (57.5 kg), 27 operation time (50 17 –163 min 19 ), and the duration when the drains are removed (from 5.7 26 –14 days 6,19 ). There is variation in the manner of skin closure, as for example, Gulluoglu et al used skin clips on all patients.…”

“…There have been several RCTs considering SAP in mastectomy with highly varying results. 4,[16][17][18][22][23][24][25][26] Most of these trials include several types of breast surgery, not just mastectomy. In the trials giving numbers for mastectomy separately, the rate of SSI is usually 6%-19%, but rates up to 41% (16/39) have been presented.…”