Antibiotic Prophylaxis After Immediate Breast Reconstruction: The Reality of Its Efficacy
Kavitha Ranganathan, M.D., Lin Zhong, M.D., M.P.H., Adeyiza O. Momoh, M.D., Kevin C. Chung, M.D., M.S., Jennifer F. Waljee, M.D., M.P.H., M.S.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE:Although postoperative antibiotic prophylaxis (PAP) is thought to minimize the risk of infection after implant-based reconstruction, the efficacy of this practice remains unclear. The goal of this study was to determine whether PAP effectively prevents failure of immediate prosthesis-based breast reconstruction due to infection.
METHODS: Using Truven MarketScan data, we identified all patients who underwent immediate reconstruction between 2009-2013 with at least 6 months of follow-up. PAP included any oral antibiotic prescription filled within 7 days prior to surgery through 24 hours post-discharge. The primary outcomes were infection and explantation due to infection. Multivariable regression analyses controlled for demographic variables and comorbidities.
RESULTS: Of the 10,784 patients who underwent immediate prosthesis-based reconstruction, 5,516 (51%) filled antibiotic prescriptions. These patients were equally likely to develop an infection (OR 1.0 95%CI(0.85-1.18); p=0.98) or require explantation (OR 0.96 95%CI(0.80-1.15); p=0.64) compared to those who did not. There was no difference in the likelihood of infection or explantation based on duration of antibiotics of 1-5 days (OR 0.85 95%CI(0.59-1.08); p=0.08), 6-10 days (OR 1.01 95%CI(0.90-1.14); p=0.84), or greater than 10 days (OR 0.97 95%CI(0.81-1.16); p=0.74). Comorbidities significantly increased the risk of infection and explantation (p<.05).
CONCLUSION: In this population-based study, PAP did not reduce the risk of infection following prosthesis-based reconstruction. Given rising rates of antibiotic resistance, focusing on management of comorbid conditions may be more valuable.
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