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Patterns of Antibiotic Use and Surgical Site Infection in Autologous Breast Reconstruction
Daniel Z. Liu, MD, Janelle A. Dubbins, MD, David W. Mathes, MD.
University fo Washington, Seattle, WA, USA.

Infection rates for surgical treatment of breast cancer are documented at 3-15%, higher than average for a clean surgical procedure. Pre and postoperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet there is no current consensus on postoperative prophylactic antibiotic use in autologous breast reconstruction.
A retrospective review of consecutive patients with autologous breast reconstruction between September 2006 and September 2010 was performed. Specific risk factors for autologous reconstruction were reviewed, including American Society of Anesthesiologists class, obesity, smoking, medical comorbidities, irradiation, and chemotherapy history. Data were collected on the type and duration of prophylactic antibiotics. The incidence of surgical site infections (SSI) was measured using Centers for Disease Control and Prevention criteria.
Two hundred and fifty-six patients with 360 breast free flaps who received both preoperative and postoperative prophylactic antibiotics were analyzed. The overall SSI rate was 17.8% (46 of 256 patients). SSI was correlated with increased age, tobacco use, prior radiation, and immediate reconstruction. The duration of postoperative antibiotic use did not differ statistically in those patients who developed SSI (6.4 days versus 7.6 days, p = 0.24). Eighty-six (34%) patients received only 24 hours of postoperative antibiotics, while 170 (66%) patients received more than 24 hours of antibiotics for a median duration of 10 days. There was no statistically significant difference in the overall SSI rate in those who received more than 24 hours of antibiotics (14% versus 24%, p = 0.055).
Characteristics of patient groups with postoperative antibiotics
VariablePostoperative Antibiotics for 24h
(n = 86)
Postoperative Antibiotics > 24h
(n = 170)
P value
Age (years), mean ± SD48.8 ± 8.249.3 ± 8.80.66
Obesity, n (%)21 (24.4)39 (22.9)0.88
Smoking, n (%)9 (10.5)14 (8.2)0.64
Diabetes mellitus, n (%)7 (8.1)10 (5.9)0.60
Prior radiotherapy, n (%)44 (51.2)72 (42.4)0.19
Prior chemotherapy, n (%)49 (57.0)84 (49.4)0.29
Immediate reconstruction, n (%)30 (34.9)48 (28.2)0.31
Antibiotic duration (days), mean ± SD1.0 ± 010.9 ± 6.0
SSI, n (%)21 (24.4)24 (14.1)0.055

There was no reduction in the overall SSI rate among those who received postoperative antibiotic prophylaxis for more than 24 hours. Due to potential adverse events related to prolonged antibiotic use, this practice is not recommended in the autologous breast reconstruction population.

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