Guideline for Antimicrobial Prophylaxis in Breast Surgery

Abstract

Antimicrobial prophylaxis has an important role in reducing surgical wound infection rates. Besides prophylaxis; basic infection control mechanisms implemented in the clinic (17), the surgeon's experience and technique, duration of operation, hospital and operating room conditions, instrumentation, preoperative preparation including body-washing, skin antisepsis and shaving, peri-operative management of temperature and blood glucose regulation, and the patient's existing co-morbidities all play an important role (16,18). Patient-related risk factors for surgical wound infections are advanced age, negative nutritional status, obesity, diabetes mellitus, cigarette smoking, presence of infection, immunodeficiency or immunosuppressive use, steroid use, recent surgery, long preoperative hospitalization and colonization with microorganisms. MicroorganismsIn breast and plastic surgery procedures, usually S. aureus is responsible for the wound infection (2,6,7,10,11,15,19,20). In axillary region procedures, obese patients prone to maceration, procedures at sweating areas P. aeruginosa, Serratia marcescens, Enterobacteriaceae including E. coli and gram-negatives like Klebsiella can be isolated (20, 21). . Pages 582-667 of this book contain the section:"Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery". This section includes current clinical developments, evidence and recommendations on the application of standard and effective antimicrobial prophylaxis in adult and pediatric patients, and has significant differences compared to the previous 1999 edition. On pages 632-633, antimicrobial prophylaxis in breast and plastic surgery practice is addressed in detail. This article contains a summary of the recommendations made in ASHP 2012/2013 Report regarding the antimicrobial prophylaxis in breast and plastic surgery applications.

Evaluation of compliance with the antibiotic prophylaxis protocol in breast surgery and its effect on the incidence of surgical infection

“…En nuestro estudio se observó una diferencia estadísticamente significativa en cuanto a la edad de las pacientes infectadas y no infectadas (64 vs 57,3 años), en consonancia con otros trabajos que muestran que la edad avanzada supone un factor de riesgo para la ISQ en cirugía de mama 14, 15 .…”

“…El microorganismo causante de ISQ más frecuente descrito en cirugía de mama fue Staphylococcus aureus 15,18,19 , al igual que en nuestra serie (47,1%), seguido de Enterobacter cloacae, por lo que la elección de antibiótico para la profilaxis quirúrgica en cirugía de mama debe cubrir a los microorganismos más comunes en esa área quirúrgica, tanto Gram positivos como negativos 15 .…”

“…Algunos trabajos no han mostrado relación entre la adecuación de la profilaxis antibiótica y la reducción de ISQ en cirugía de mama 5,12 ni en otras cirugías limpias 24 , aunque cabe destacar que contaron con un tamaño muestral limitado y los porcentajes de cumplimiento en estos estudios fueron pobres. En un metaanálisis realizado con nueve estudios y 2.260 pacientes se concluyó a favor de la recomendación de la profilaxis antibiótica como método para reducir la infección quirúrgica en cirugía de mama 20 , hecho señalado también en múltiples estudios 15,16,25 .…”

Peer Review #1 of "Surgical antibiotic prophylaxis use and infection prevalence in non-cosmetic breast surgery procedures at a tertiary hospital in Western Australia—a retrospective study (v0.1)"

“…Vancomycin or clindamycin are second-line choices for SSI prophylaxis in cases where cefalosporin antibiotics were contraindicated [20]. Possible reasons for reluctance by clinician to PeerJ reviewing PDF | (2018:02:25357:2:0:NEW 30 Aug 2018)…”

Surgical antibiotic prophylaxis use and infection prevalence in non-cosmetic breast surgery procedures at a tertiary hospital in Western Australia—a retrospective study

“…It was found that none of the prescribers adhered to the eTG and had prescribed either cefazolin or clindamycin instead of vancomycin as stipulated in the eTG. Vancomycin or clindamycin are second-line choices for SSI prophylaxis in cases where cefalosporin antibiotics were contraindicated ( Baghaki, Soybir & Soran, 2014 ). Possible reasons for reluctance by clinician to prescribe vancomycin include adverse effects such as red man syndrome which may limit its use for some surgeons.…”