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Curr Treat Options Infect Dis. 2017 Jun;9(2):155-172. doi: 10.1007/s40506-017-0117-9. Epub 2017 May 11.

Surveillance and Prevention of Surgical Site Infections in Breast Oncologic Surgery with Immediate Reconstruction.

Author information

1
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine.
2
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine.
3
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.

Abstract

Surgical site infection (SSI) after immediate breast reconstruction is much more common than would be expected after a clean surgical procedure. Although the SSI rates reported in individual studies are quite variable, there are no obvious explanations for the variation in infection rates between institutions. The microbiology of these SSIs is unusual, with higher proportions of infections caused by atypical Myobacterium species and Gram-negative bacilli than would be expected for this anatomic site. In an effort to prevent SSIs, many surgeons use a variety of different practices including irrigation and soaking of implants with antibiotic solutions and prolonged duration of prophylactic antibiotics, although the literature to support these practices is very sparse. In particular, prolonged use of antibiotics post-discharge is concerning due to the potential for harm, including increased risk of Clostridium difficile infection, development of antibiotic resistant organisms, and drug-related allergic reactions. With higher rates of mastectomy and breast implant reconstruction in women with early-stage breast cancer, including greater utilization of reconstruction in higher-risk individuals, the number of women suffering from infection after oncologic reconstruction will likely continue to increase. It is imperative that more research be done to identify modifiable factors associated with increased risk of infection. It is also essential that larger studies with rigorous study designs be performed to identify optimal strategies to decrease the risk of SSI in this vulnerable population.

KEYWORDS:

Surgical site infection; breast reconstruction; epidemiology; mastectomy; prevention; risk factors

Conflict of interest statement

Conflict of Interest Dr. Margaret A. Olsen declares consultant fees, advisory board membership, and grant support from Pfizer, as well as grant support from Sanofi Pasteur, outside of the submitted work. Dr. Katelin B. Nickel and Ida K. Fox declare that they have no conflicts of interest.

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