Plastic Surgery Research Council
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Presenter: Brett T Phillips, MD
Co-Authors: Fourman MS; Dagum AB; Huston TL; Ganz JC; Khan SU; Bui DT
Stony Brook University Medical Center

Background: Antibiotics and closed suction drains are routinely used in postoperative tissue expander based immediate breast reconstruction (TE-IBR). Prophylactic postoperative antibiotics are prescribed due to the presence of implants, drains, and a high associated infection rate. CDC guidelines for antibiotic prophylaxis are recommended for only 24-hours. There are no randomized controlled trials suggesting that extended antibiotic prophylaxis is beneficial to these patients. This study evaluates the difference in surgical site infection (SSI) between perioperative and postoperative antibiotics.

Methods: A non-inferiority prospective randomized controlled trial was designed in which TE-IBR patients are randomized to receiving 24-hours of antibiotics only or to receiving continued postoperative oral antibiotics until drain removal. The primary outcome was SSI as defined by the CDC. Operative and postoperative protocols were standardized. Endpoints were one year after first-stage reconstruction, second-stage, SSI, implant loss, or re-operation.

Results: 86 TE-IBR patients (137 breasts) were randomized into two study arms. 44 patients were randomized to the extended antibiotic group, while 42 patients were in the 24-hour antibiotic group. The patient s average age was 49 (range: 28-77), with mean f/u time of 12.3 months (range: 0.5 23). There were 13 patients with SSI (15.1%), 6 patients in extended group and 7 patients in 24-hour group (13.6%, 16.7%, respectively). The extended group had 4 patients requiring IV antibiotics and all lost their expander (9.1%). The 24-hour group had 2 patients requiring IV antibiotics and one underwent removal of the expander (2.4%).

Conclusion: Preliminary results suggest that 24-hours of antibiotics is not inferior to extended oral antibiotics with regards to the primary outcome of SSI in TE-IBR patients. Extended antibiotic administration can lead to systemic side effects, super-infection, and development of resistant organisms. Future multicenter trials will confirm which antibiotic protocol provides superior postoperative care to TE-IBR patients.

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