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A Systematic Review of Antibiotic Use and Infection in Breast Reconstruction: What Is the Evidence?

Phillips, Brett T. M.D., M.B.A.; Bishawi, Muath B.S.; Dagum, Alexander B. M.D.; Khan, Sami U. M.D.; Bui, Duc T. M.D.

Plastic & Reconstructive Surgery: January 2013 - Volume 131 - Issue 1 - p 1–13
doi: 10.1097/PRS.0b013e3182729c39
Breast: Outcomes Article

Background: The literature reports overall complication rates in breast reconstruction to be as high as 60 percent. Infection rates can exceed 20 percent, much higher than anticipated in clean elective surgery. There is no consensus among surgeons regarding the necessary duration of antibiotic prophylaxis, although the Centers for Disease Control and Prevention guidelines suggest only 24 hours. This systematic review examines antibiotic regimens and associated infection rates in breast reconstruction.

Methods: Systematic electronic searches were performed in the PubMed, Ovid, and Cochrane databases using Medical Subject Headings terms for studies reporting antibiotic use and infection in all forms of breast reconstruction. Studies between 1970 and 2011 were reviewed. Included publications were required to report an antibiotic protocol and infection rate.

Results: A total of 834 abstracts were identified, 81 of which met inclusion criteria and were included in the review. The overall reported infection rates in the included studies varied between 0 and 29 percent (average, 5.8 percent). When comparing combined patient cohorts receiving no antibiotics, less than 24 hours, and greater than 24 hours, the average infection rates were 14.4, 5.8, and 5.8 percent, respectively.

Conclusions: There is no consensus on the necessary duration of antibiotic prophylaxis following breast reconstruction. No benefit was found in patients who received more than 24 hours of postoperative antibiotics. Standardized definitions for antibiotic regimens, unit of analysis reporting, and a new breast reconstruction surgical-site infection grading system are offered to improve standardized outcome documentation. Randomized controlled trials are warranted to best determine an optimal antibiotic regimen.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Stony Brook, N.Y.

From the Division of Plastic and Reconstructive Surgery, Stony Brook University Medical Center, and the Stony Brook University School of Medicine.

Received for publication May 28, 2012; accepted July 5, 2012.

Presented at the 19th Annual Meeting of the American Society for Reconstructive Microsurgery, in Las Vegas, Nevada, January 14 through 17, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Brett T. Phillips, M.D., M.B.A.; Department of Surgery, Stony Brook University Medical Center, HSC T19 Room 020, Stony Brook, N.Y. 11794-8191, brett.phillips@stonybrook.edu

©2013American Society of Plastic Surgeons