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Prevalence and Predictors of Postdischarge Antibiotic Use Following Mastectomy

Published online by Cambridge University Press:  03 July 2017

Margaret A. Olsen ,
Katelin B. Nickel ,
Victoria J. Fraser ,
Anna E. Wallace  and
David K. Warren
Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
Katelin B. Nickel
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Anna E. Wallace
Affiliation:
HealthCore, Inc, Wilmington, Delaware
David K. Warren
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
*
Address correspondence to Margaret A. Olsen, PhD, MPH, Washington University School of Medicine, Division of Infectious Diseases, 4523 Clayton Ave, Campus Box 8051, St Louis, MO 63110 (molsen@wustl.edu).
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Abstract

OBJECTIVE

Survey results suggest that prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction.

DESIGN

Retrospective cohort.

PATIENTS

Commercially insured women aged 18–64 years coded for mastectomy from January 2004 to December 2011 were included in the study. Women with a preexisting wound complication or septicemia were excluded.

METHODS

Predictors of prophylactic antibiotics within 5 days after discharge were identified in women with 1 year of prior insurance enrollment; relative risks (RR) were calculated using generalized estimating equations.

RESULTS

Overall, 12,501 mastectomy procedures were identified; immediate reconstruction was performed in 7,912 of these procedures (63.3%). Postdischarge prophylactic antibiotics were used in 4,439 procedures (56.1%) with immediate reconstruction and 1,053 procedures (22.9%) without immediate reconstruction (P<.001). The antibiotics most commonly prescribed were cephalosporins (75.1%) and fluoroquinolones (11.1%). Independent predictors of postdischarge antibiotics were implant reconstruction (RR, 2.41; 95% confidence interval [CI], 2.23–2.60), autologous reconstruction (RR, 2.17; 95% CI, 1.93–2.45), autologous reconstruction plus implant (RR, 2.11; 95% CI, 1.92–2.31), hypertension (RR, 1.05; 95% CI, 1.00–1.10), tobacco use (RR, 1.07; 95% CI, 1.01–1.14), surgery at an academic hospital (RR, 1.14; 95% CI, 1.07–1.21), and receipt of home health care (RR, 1.11; 95% CI, 1.04–1.18). Postdischarge prophylactic antibiotics were not associated with SSI after mastectomy with or without immediate reconstruction (both P>.05).

CONCLUSIONS

Prophylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. Stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.

Infect Control Hosp Epidemiol 2017;38:1048–1054

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 9 , September 2017 , pp. 1048 - 1054
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. This work was presented at the International Conference on Pharmacoepidemiology and Therapeutic Risk Management in Dublin, Ireland, on August 26, 2016.

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