Antibiotic prophylaxis with teicoplanin in patients undergoing breast reconstruction with the transverse rectus abdominis myocutaneous flap

Abstract

The authors report the results of a randomized clinical trial of antibiotic prophylaxis for post-operative infection following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap. The aim was to evaluate the efficacy and tolerability of short-term parenteral prophylaxis with teicoplanin; the endpoint of the study was the reduction of wound contamination assessed by microbiologic culture of drain fluid. From October 1990 to March 1992, 38 patients were recruited: 20 patients were included in the antibiotic prophylaxis arm (teicoplanin i.v. 400 mg one hour before operation and in the following 12 h plus 200 mg i.v. at 24 h after operation) and 18 patients in the control group. Analysis of drain fluid showed a higher contamination (15/18=83%) in the control group (Staphylococcus epidermides, Streptococcus alfa-emoliticus, Enterobacter aerogenes, Peptostreptococcus magnus)as compared to the prophylaxis arm with teicoplanin (2/20=10%) (Staphylococcus coagulase-negative) (p< 0.0001). Moreover, 11 patients in the control group suffered from fever > 37.5 ° C as compared to one patient in the antibiotic prophylaxis group (p<0.0001); the post-operation stay was 13.3+4.3 and 9.0_+1.6 in the control and antibiotic arm, respectively (p = 0.0002). There were no antibiotic related side effect in this study. These results seem to confirm the value of parenteral short-term antibiotic prophylaxis of post-operative infection in this type of "clean" operative procedure.

A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery

“…Antrum, 1990 113 Interim analysis of Kester, 1999 23 Antrum, 1992 114 Interim analysis of Kester, 1999 23 Barlas, 1993 115 CCT but not assessing a glycopeptide (full paper was ordered as no abstract was available) Bayston, 1990 116 Not adult participants only Bell, 1990 117 Not a CCT (case series: full paper was ordered as no abstract was available) Brooks, 2002 118 Not a CCT (prospective cohort study) Bucknell, 2000 119 CCT but not assessing a glycopeptide (only MRSA high-risk patients received a glycopeptide) Cone, 2004 120 Duplicate of Mastronardi, 2004 121 Dazzi, 1994 122 Comparator not an alternative antibiotic regimen de Lalla, 2000 123 Comparator not an alternative antibiotic regimen de Lalla, 2001 124 Discussion paper (full paper was ordered as no abstract was available) De Lucas-Villarrubia, 2004 125 Not a CCT (prospective cohort study) Exner, 1992 126 Not a CCT (prospective cohort study) Ferro, 1997 127 Comparator not an alternative antibiotic regimen Feys, 1997 128 Comparator not an alternative antibiotic regimen Fontanesi, 1991 129 Discussion paper (full paper was ordered as no abstract was available) Franchelli, 1993 130 Comparator not an alternative antibiotic regimen Friberg, 1990 131 Not a CCT (case reports: full paper was ordered as no abstract was available) Gadallah, 2000 132 Not adult participants only. Primary outcome was peritonitis, SSIs were excluded from the analysis Haines, 1993 133 Letter Isringhaus, 1992 134 Not a CCT (pharmacokinetic study: all patients received same dose of glycopeptide) Karran, 1992 135 Comparator not an alternative antibiotic regimen Lazzarini, 2001 136 Not a CCT (prospective cohort) Lazzarini, 2003 137 Does not report a primary outcome (primary outcome is blood drug concentration) Mastronardi, 2004 121 Not a CCT (retrospective cohort) Mendivil Soto, 2001 138 Does not report a primary outcome Mini, 1999…”

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 and postoperative antibiotics for 1 day may decrease SSI compared with placebo, but with very low certainty (RR, 0.08; 95% CI, 0.01 to 0.57; 38 participants; one study; P = 0.01; very-low-certainty evidence). 17 Evidence: Uncertain support for preoperative and postoperative systemic antibiotics for 1 day. 16,17…”

“…17 Evidence: Uncertain support for preoperative and postoperative systemic antibiotics for 1 day. 16,17…”

The Duration of Postoperative Antibiotics in Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis

“…Breast surgery is considered to be a clean surgery, and per the Centers for Disease Control and Prevention and the Surgical Care Improvement Project, antibiotic prophylaxis is recommended for a maximum of 24 hours [7]. This has been evidenced by Amland et al as well as Franchelli et al who have shown a reduction in the incidence of SSIs in autologous breast reconstruction post-mastectomy when compared to patients who did not receive any antibiotic prophylaxis [14,15]. Studies included within the quantitative assessment of this review demonstrated good comparability for underlying variables.…”