AI Article Synopsis
- Breast reconstruction has high complication and infection rates, with no consensus on optimal antibiotic duration for prophylaxis, although CDC guidelines suggest 24 hours.
- A systematic review analyzed 81 studies from 1970 to 2011, finding varying infection rates, with an average of 5.8% across different antibiotic protocols.
- The review concluded that there is no additional benefit for antibiotic use beyond 24 hours, highlighting the need for standardized definitions and randomized trials to determine effective antibiotic regimens.
Article Abstract
Background: The literature reports overall complication rates in breast reconstruction to be as high as 60 percent. Infection rates can exceed 20 percent, much higher than anticipated in clean elective surgery. There is no consensus among surgeons regarding the necessary duration of antibiotic prophylaxis, although the Centers for Disease Control and Prevention guidelines suggest only 24 hours. This systematic review examines antibiotic regimens and associated infection rates in breast reconstruction.
Methods: Systematic electronic searches were performed in the PubMed, Ovid, and Cochrane databases using Medical Subject Headings terms for studies reporting antibiotic use and infection in all forms of breast reconstruction. Studies between 1970 and 2011 were reviewed. Included publications were required to report an antibiotic protocol and infection rate.
Results: A total of 834 abstracts were identified, 81 of which met inclusion criteria and were included in the review. The overall reported infection rates in the included studies varied between 0 and 29 percent (average, 5.8 percent). When comparing combined patient cohorts receiving no antibiotics, less than 24 hours, and greater than 24 hours, the average infection rates were 14.4, 5.8, and 5.8 percent, respectively.
Conclusions: There is no consensus on the necessary duration of antibiotic prophylaxis following breast reconstruction. No benefit was found in patients who received more than 24 hours of postoperative antibiotics. Standardized definitions for antibiotic regimens, unit of analysis reporting, and a new breast reconstruction surgical-site infection grading system are offered to improve standardized outcome documentation. Randomized controlled trials are warranted to best determine an optimal antibiotic regimen.
Clinical Question/level Of Evidence: Therapeutic, III.
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| http://dx.doi.org/10.1097/PRS.0b013e3182729c39 | DOI Listing |
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