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Breast Tissue Expander—Related Infections: Perioperative Antimicrobial Regimens

Published online by Cambridge University Press:  10 May 2016

George M. Viola ,
Issam I. Raad  and
Kenneth V. Rolston
George M. Viola*
Affiliation:
Division of Medicine, Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas
Issam I. Raad
Affiliation:
Division of Medicine, Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas
Kenneth V. Rolston
Affiliation:
Division of Medicine, Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas
*
University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030 (gmviola@mdanderson.org)
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Abstract

Objective.

The rate of postmastectomy tissue expander (TE) infection remains excessively high, ranging between 2% and 24%. We hypothesized that current perioperative antimicrobial regimens utilized for breast TE reconstruction may be outdated as a result of recent changes in microflora and susceptibility patterns.

Design and Methods.

We reviewed the records of all patients who had a TE reconstructive procedure and developed a definite breast TE infection between 2003 and 2010 at MD Anderson Cancer Center. Antimicrobials were stratified into 3 groups: systemic perioperative, local irrigation, and oral immediate postoperative antimicrobials. These were considered discordant if they did not target the isolated organisms, while a breakthrough infection was defined as an infection that occurred despite concordant antimicrobial coverage.

Results.

Overall, 75 patients with a definite TE infection were identified. The most common organisms identified were methicillin-resistant Staphylococcus epidermidis (29%), methicillin-resistant Staphylococcus aureus (15%), and gram-negative rods (26%). The use of systemic perioperative antimicrobials was deemed discordant in 51% of the cases. Although 79% of the patients received broad-spectrum perioperative local antimicrobial irrigation, 63% developed a breakthrough infection. Even though 61% received oral postoperative prophylactic antimicrobials, 63% of the times they were deemed discordant.

Conclusions.

Contrary to the proven effectiveness of a single dose of perioperative antibiotics, the common use of local antimicrobial irrigation and prolonged postoperative oral antibiotics appears to be an inadequate component of our preventive armamentarium. Also, because methicillin-resistant staphylococcal and pseudomonal infections occurred approximately 60% of the time, at institutions that have observed an increase of these organisms, it may be prudent that perioperative antimicrobials target these microorganisms.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 1 , January 2014 , pp. 75 - 81
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. McGuire, KP, Santillan, AA, Kaur, P, et al. Are mastectomies on the rise? a 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol 2009;16(10):2682–2690.Google Scholar
2. Damie, S, Teal, CB, Lenert, JJ, Marshall, EC, Pan, Q, McSwain, AP. Mastectomy and contralateral prophylactic mastectomy rates: an institutional review. Ann Surg Oncol 2011;18(5):1356–1363.Google Scholar
3. Warren Peled, A, Itakura, K, Foster, RD, et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction. Arch Surg 2010;145(9):880–885.Google Scholar
4. American Society of Plastic Surgeons (ASPS). 2012 Plastic Surgery Statistics Report. Arlington Heights, IL: ASPS, 2012. http://www.plasticsurgery.org/Documents/news-resources/statistics/2012-Plastic-Surgery-Statistics/full-plastic-surgery-statistics-report.pdf. Accessed August 2, 2013.Google Scholar
5. Halvorson, EG, Disa, JJ, Mehrara, BJ, Burkey, BA, Pusic, AL, Cordeiro, PG. Outcome following removal of infected tissue expanders in breast reconstruction: a 10-year experience. Ann Plast Surg 2007;59(2):131–136.CrossRefGoogle Scholar
6. Radovan, C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg 1982;69(2):195–208.Google Scholar
7. Nahabedian, MY, Tsangaris, T, Momen, B, Manson, PN. Infectious complications following breast reconstruction with expanders and implants. Plast Reconstr Surg 2003;112(2):467–476.CrossRefGoogle ScholarPubMed
8. Pittet, B, Montandon, D, Pittet, D. Infection in breast implants. Lancet Infect Dis 2005;5(2):94–106.Google Scholar
9. Khan, UD. Breast augmentation, antibiotic prophylaxis, and infection: comparative analysis of 1,628 primary augmentation mammoplasties assessing the role and efficacy of antibiotics prophylaxis duration. Aesthetic Plast Surg 2010;34(1):42–47.Google Scholar
10. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309–332.Google Scholar
11. Bratzier, DW, Dellinger, EP, Olsen, KM. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70(3):195–283.Google Scholar
12. Cordeiro, PG, McCarthy, CM. A single surgeon's 12-year experience with tissue expander/implant breast reconstruction. I. A prospective analysis of early complications. Plast Reconstr Surg 2006;118(4):825–831.CrossRefGoogle Scholar
13. Armstrong, RW, Berkowitz, RL, Bolding, F. Infection following breast reconstruction. Ann Plast Surg 1989;23(4):284–288.Google Scholar
14. Spear, SL, Majidian, A. Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants: a retrospective review of 171 consecutive breast reconstructions from 1989 to 1996. Plast Reconstr Surg 1998;101(1):53–63.Google Scholar
15. Francis, SH, Ruberg, RL, Stevenson, KB. Independent risk factors for infection in tissue expander breast reconstruction. Plast Reconstr Surg 2009;124(6):1790–1796.Google Scholar
16. Handel, N, Jensen, JA, Black, Q, Waisman, JR, Silverstein, MJ. The fate of breast implants: a critical analysis of complications and outcomes. Plast Reconstr Surg 1995;96(7):1521–1533.CrossRefGoogle ScholarPubMed
17. Disa, JJ, Ad-El, DD, Cohen, SM, Cordeiro, PG, Hidalgo, DA. The premature removal of tissue expanders in breast reconstruction. Plast Reconstr Surg 1999;104(6):1662–1665.Google Scholar
18. Cordeiro, PG, Pusic, AL, Disa, JJ, McCormick, B, VanZee, K. Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 2004;13(3):877–881.Google Scholar
19. Araco, A, Gravante, G, Araco, F, Delogu, D, Cervelli, V, Walgenbach, K. Infections of breast implants in aesthetic breast augmentations: a single-center review of 3,002 patients. Aesthetic Plast Surg 2007;31(4):325–329.Google Scholar
20. Degnim, AC, Scow, JS, Hoskin, TL, et al. Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations. Ann Surg 2013;258(2):240–247.Google Scholar
21. Vandeweyer, E, Deraemaecker, R, Nogaret, JM, Hertens, D. Immediate breast reconstruction with implants and adjuvant chemotherapy: a good option? Acta Chir Belg 2003;103(1):98–101.Google Scholar
22. Piper, M, Peled, AW, Foster, RD, Moore, DH, Esserman, LJ. Total skin-sparing mastectomy: a systematic review of oncologic outcomes and postoperative complications. Ann Plast Surg 2013.Google Scholar
23. Reish, RG, Damjanovic, B, Austen, WG Jr, et al. Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. Plast Reconstr Surg 2013;131(6):1223–1230.Google Scholar
24. Mortenson, MM, Schneider, PD, Khatri, VP, et al. Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed. Arch Surg 2004;139(9):988–991.Google Scholar
25. Tejirian, T, DiFronzo, LA, Haigh, PI. Antibiotic prophylaxis for preventing wound infection after breast surgery: a systematic review and metaanalysis. J Am Coll Surg 2006;203(5):729–734.Google Scholar
26. Throckmorton, AD, Hoskin, T, Boostrom, SY, et al. Complications associated with postoperative antibiotic prophylaxis after breast surgery. Am J Surg 2009;198(4):553–556.Google Scholar
27. Bratzler, DW, Houck, PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005;189(4):395–104.Google Scholar
28. Feldman, EM, Kontoyiannis, DP, Sharabi, SE, Lee, E, Kaufman, Y, Heller, L. Breast implant infections: is cefazolin enough? Plast Reconstr Surg 2010;126(3):779–785.CrossRefGoogle Scholar
29. Phillips, BT, Wang, ED, Mirrer, J, Lanier, ST, Khan, SU, Dagum, AB, Bui, DT. Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care. Ann Plast Surg 2011;66(5):460–465.Google Scholar
30. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20(4):250–278.Google Scholar
31. Adams, WP Jr, Conner, WC, Barton, FE Jr, Rohrich, RJ. Optimizing breast-pocket irrigation: the post-betadine era. Plast Reconstr Surg 2001;107(6):1596–1601.Google Scholar
32. Adams, WP Jr, Conner, WC, Barton, FE Jr, Rohrich, RJ. Optimizing breast pocket irrigation: an in vitro study and clinical implications. Plast Reconstr Surg 2000;105(1):334–338.Google Scholar
33. Adams, WP Jr, Rios, JL, Smith, SJ. Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Stirg 2006;118(7 suppl):46S–52S.CrossRefGoogle ScholarPubMed
34. Pfeiffer, P, Jorgensen, S, Kristiansen, TB, Jorgensen, A, Holmich, LR. Protective effect of topical antibiotics in breast augmentation. Plast Reconstr Surg 2009;124(2):629–634.Google Scholar
35. Washer, LL, Gutowski, K. Breast implant infections. Infect Dis Clin North Am 2012;26(1):111–125.Google Scholar
36. Zanetti, G, Goldie, SJ, Piatt, R. Clinical consequences and cost of limiting use of vancomycin for perioperative prophylaxis: example of coronary artery bypass surgery. Emerg Infect Dis 2001;7(5):820–827.Google Scholar
37. Elliott, RA, Weatherly, HL, Hawkins, NS, et al. An economic model for the prevention of MRSA infections after surgery: non-glycopeptide or glycopeptide antibiotic prophylaxis? Eur J Health Econ 2010;11(1):57–66.Google Scholar
38. Cranny, G, Elliott, R, Weatherly, H, et al. A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery. Health Technol Assess 2008;12(1): iii-iv, xi-xii, 1–147.Google Scholar
39. Crawford, T, Rodvold, KA, Solomkin, JS. Vancomycin for surgical prophylaxis? Clin Infect Dis 2012;54(10):1474–1479.Google Scholar
40. Alexander, JW, Solomkin, JS, Edwards, MJ. Updated recommendations for control of surgical site infections. Ann Surg 2011;253(6):1082–1093.Google Scholar