Extended Antibiotic Prophylaxis Not Beneficial After Postmastectomy Breast Reconstruction

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Extended antibiotics do not reduce infection or reconstruction failure after postmastectomy breast reconstruction.

HealthDay News — For patients undergoing postmastectomy breast reconstruction (PMBR), extended antibiotic prophylaxis (EAP) does not prevent infection, admission, reoperation, or explantation rates, according to a study published in the May issue of Plastic and Reconstructive Surgery.

Mark Sisco, MD, from NorthShore University HealthSystem in Evanston, Illinois, and colleagues conducted a retrospective study of 1077 women who underwent immediate prosthetic PMBR from January 2008 to May 2020 to compare 90-day outcomes between EAP-positive and EAP-negative approaches. All patients received intravenous antibiotics preoperatively and up to 24 hours after surgery; before October 2016, patients also received oral antibiotics until drain removal (EAP). The EAP-positive and EAP-negative groups included 1004 and 683 breasts, respectively.

The researchers observed no differences between the EAP-positive and EAP-negative groups in terms of surgical site infection (odds ration [OR], 0.83; 95% CI], 0.56 to 1.25; P =.38), admission (OR, 0.78; 95% CI, 0.41 to 1.48; P =.44), reoperation (OR, 1.01; 95% CI, 0.68 to 1.48; P =.97), or explantation rates (OR, 1.06; 95% CI, 0.66 to 1.71; P =.81). The likelihood of developing gram-negative infections was increased in the EAP-positive group. Thirteen (2.0%) and 4 (0.6%) EAP-positive women, respectively, developed allergic reactions and Clostridium difficile colitis attributable to the EAP.

“We hope that our experience will give surgeons additional evidence and courage to change their practice,” the authors write.

One author disclosed financial ties to Surgical Innovation Associates.

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