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Antibiotic Prophylaxis for Preventing Surgical-Site Infection in Plastic Surgery: An Evidence-Based Consensus Conference Statement from the American Association of Plastic Surgeons

Ariyan, Stephan M.D., M.B.A.; Martin, Janet Pharm.D.; Lal, Avtar Ph.D.; Cheng, Davy M.D.; Borah, Gregory L. M.D., D.M.D.; Chung, Kevin C. M.D., M.S.; Conly, John M.D.; Havlik, Robert M.D.; Lee, W. P. Andrew M.D.; McGrath, Mary H. M.D., M.P.H.; Pribaz, Julian M.D.; Young, V. Leroy M.D.

Plastic and Reconstructive Surgery: June 2015 - Volume 135 - Issue 6 - p 1723–1739
doi: 10.1097/PRS.0000000000001265
Special Topics: Original Article

Background: There is a growing concern for microbial resistance as a result of overuse of antibiotics. Although guidelines have focused on the use of antibiotics for surgery in general, few have addressed plastic surgery specifically. The objective of this expert consensus conference was to evaluate the evidence for efficacy and safety of antibiotic prophylaxis in plastic surgical procedures.

Methods: The authors searched for existing high-quality systematic reviews for antibiotic prophylaxis in the literature from the MEDLINE, Cochrane Library, and Embase databases. All synonyms for antibiotics were combined with terms for relevant plastic surgery procedures. The searches were not limited by language, and included all study designs. In addition, supplemental hand searches were performed of bibliographies of relevant articles, and extensive “related articles.” Meta-analyses were performed and reviewed by experts selected by the American Association of Plastic Surgeons to reach consensus recommendations.

Results: Database searches identified 4300 articles, from which 2042 full-text articles were identified for eligibility. De novo meta-analyses were performed for each plastic surgical category. In total, 67 studies met the inclusion criteria, including nine for breast surgery, 17 for head and neck surgery, 10 for orthognathic surgery, seven for rhinoplasty/septoplasty, 19 for hand surgery, five for skin surgery, and two for abdominoplasty.

Conclusions: Systemic antibiotic prophylaxis is recommended for clean breast surgery and for contaminated surgery of the hand or the head and neck. It is not recommended to reduce infection in clean surgical cases of the hand, skin, head and neck, or abdominoplasty.

New Haven, Conn.; New Brunswick, N.J.; Ann Arbor, Mich.; Milwaukee, Wis.; Baltimore, Md.; San Francisco, Calif.; Boston, Mass.; Washington, Mo.; and London, Ontario, and Calgary, Alberta, Canada

From the Department of Surgery (Plastic Surgery), Yale University; the Department of Surgery, University of Medicine and Dentistry of New Jersey; the Department of Surgery, University of Michigan; the Department of Plastic Surgery, Medical College of Wisconsin; the Department of Surgery, Johns Hopkins University; the Department of Surgery, University of California, San Francisco; the Department of Surgery, Harvard University; Mercy Health Research; the Department of Anesthesia and Perioperative Medicine, Western University; and the Department of Medicine, Microbiology, Immunology and Infectious Diseases, and Snyder Institute for Chronic Diseases, University of Calgary.

Received for publication July 24, 2014; accepted December 19, 2014.

Disclosure: Dr. Conly has received honoraria from the Canadian Agency for Drugs and Technologies in Health for work as an expert reviewer and clinical expert, respectively, for projects on the role of rapid polymerase chain reaction testing for methicillin-resistant Staphylococcus aureus in hospitalized patients and the use of vancomycin or metronidazole for treatment of Clostridium difficile colitis within the past 3 years. He has also received speaker’s honoraria and/or travel support related to new antibacterial agents and antimicrobial resistance from Pfizer and BioMérieux during the past 3 years. He has received financial support for research activities from the Alberta Innovates-Health Solutions, the Canadian Institutes for Health Research, and Pfizer. No financial support or benefits have been received by any of the other coauthors from any commercial source that is related directly or indirectly to the work which is reported on in this article.

Stephan Ariyan, M.D., M.B.A., P.O. Box 208041, New Haven, Conn. 06520-8041, stephan.ariyan@yale.edu

©2015American Society of Plastic Surgeons