Do Postoperative Prophylactic Antibiotics Reduce Highly Virulent Infections?

Abstract

Background Many surgeons are reluctant to discontinue prophylactic antibiotics after 24 hours in tissue expander breast reconstruction (TEBR) because of fear of increased risk of surgical site infection (SSI). Currently, there is no consensus regarding antibiotic prophylaxis duration in TEBR. In addition, there remains a lack of research investigating microorganisms involved in SSI across various perioperative antibiotic protocols. The purpose of this study was to examine how 2 different prophylactic antibiotic regimens impacted the bacterial profiles of SSI and rate of implant loss after TEBR. Methods A single-institution retrospective review of immediate TEBRs between 2001 and 2018 was performed. Surgical site infections requiring hospitalization before stage 2 were included. Highly virulent organisms were defined as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species). Implant loss was defined as removal of tissue expander without immediate replacement. Results Of 660 TEBRs, 85 (12.9%) developed an SSI requiring hospitalization before stage 2. Fifty-six (65.9%) received less than 24 hours of perioperative intravenous antibiotics and oral antibiotics after discharge (group 1), and 29 (34.1%) received less than 24 hours of intravenous antibiotics only (group 2). There was no significant difference in demographics, preoperative chemotherapy/radiation, acellular dermal matrix usage, or treatment of SSI between groups. In group 1, 64% (n = 36) developed culture positive SSIs, compared with 83% (n = 24) in group 2 (P = 0.076). Staphylococcus aureus was the most common bacteria in both groups. Group 2 demonstrated a significantly increased incidence of gram-positive organisms (46.4% vs 72.4%, P = 0.022) and S. aureus (21.4% vs 55.2%, P = 0.002). However, there was no significant difference in overall highly virulent (P = 0.168), gram-negative (P = 0.416), or total isolated organisms (P = 0.192). Implant loss between groups 1 and 2 (62.5% vs 62.1%, P = 0.969) respectively, was nearly identical. Conclusions Our study demonstrates that, despite differences in bacterial profiles between 2 antibiotic protocols, prolonged postoperative antibiotic use did not protect against overall highly virulent infections or implant loss. Antibiotic stewardship guidelines against the overuse of prolonged prophylactic regimens should be considered. Further analysis regarding timing of SSIs and antibiotic treatment is warranted.

Microbiology of breast tissue expanders

“…Due to the lack of a larger research group or positive bacteriological culture results, we were unable to determine a specific group of bacteria associated with expanders. It is crucial to notice, however, that the bacteria grown in our cultures belong to the saprophytic flora of the human skin, which is also confirmed by the results of studies carried out by other researchers [ 8 , 12 – 14 ]. Therefore, we believe that paying attention to the proper preparation of the surgical field and the utmost care for asepsis constitute important predictive factors of infections.…”

“…On the other hand, interesting results were presented by Monroig et al . in a paper published in 2020 [ 14 ]. They compared 2 groups of patients after tissue expander breast reconstruction.…”

“…Gram-positive bacteria were detected significantly more often compared to Gram-negative (73% vs. 27%) [ 12 ]. The most frequently encountered organisms responsible for the infection include Staphylococcus aureus, Staphylococcus epidermidis , and Pseudomonas aeruginosa [ 8 , 12 – 14 ].…”

Changes in resistance pattern of ESKAPE pathogens between 2010 and 2020 in the clinical center of University of Szeged, Hungary

“…The World Health Organisation has also recognized the importance of this area and has allocated resources for its research [3]. In parallel, local initiatives have been launched to assess the regional ESKAPE pathogen situation and to develop antimicrobial stewardship programs that can respond to this challenge effectively [11][12][13][14]. In line with this, we have also attempted to explore and predict the ESKAPE problem in our local care area.…”

Overview of Risk Factors and Prevention of Capsular Contracture Following Implant-Based Breast Reconstruction and Cosmetic Surgery: A Systematic Review

“…Staphylococci species are the most common axillary flora, and antibiotics targeted at these species do not show a significant impact on SSIs [ 23 ]. Preoperative prophylaxis has not significantly reduced SSIs in breast cancer surgery [ 24 ], and prolonged postoperative antibiotic prophylaxis also has not shown to decrease implant loss or highly virulent infections [ 25 ]. Patient compliance plays an important role in preventing SSIs, and medication noncompliance doubles the risk of infection in breast surgery [ 26 ].…”