Antibiotic Implant Irrigation and Deep Infection: A Retrospective Study of 1508 Patients Undergoing Breast Reconstruction with Implants.

Autor:	Hemmingsen MN; From the Departments of Plastic Surgery and Burns Treatment., Bennedsen AK; From the Departments of Plastic Surgery and Burns Treatment., Kullab RB; From the Departments of Plastic Surgery and Burns Treatment., Weltz TK; From the Departments of Plastic Surgery and Burns Treatment., Larsen A; From the Departments of Plastic Surgery and Burns Treatment., Ørholt M; From the Departments of Plastic Surgery and Burns Treatment., Norlin CB; From the Departments of Plastic Surgery and Burns Treatment., Kalstrup J; Department of Plastic and Reconstructive Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital., Bredgaard R; From the Departments of Plastic Surgery and Burns Treatment., Sørensen SJ; Section of Microbiology, Department of Biology., Bjarnsholt T; Clinical Microbiology, Rigshospitalet.; Department of Immunology and Microbiology., Hölmich LR; Department of Plastic and Reconstructive Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital.; Department of Clinical Medicine, University of Copenhagen., Damsgaard TE; From the Departments of Plastic Surgery and Burns Treatment.; Department of Clinical Medicine, University of Copenhagen., Vester-Glowinski P; From the Departments of Plastic Surgery and Burns Treatment., Herly M; From the Departments of Plastic Surgery and Burns Treatment.; Department of Immunology and Microbiology.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2024 Jul 01; Vol. 154 (1), pp. 5-13. Date of Electronic Publication: 2023 Jun 20.
DOI:	10.1097/PRS.0000000000010869
Abstrakt:	Background: Antibiotic implant irrigation is increasingly used to prevent deep infection after implant-based breast reconstruction. However, there is limited evidence of the clinical effect. In this study, the authors compare the risk of a deep infection in a Danish population of women who received antibiotic implant irrigation with either gentamicin or vancomycin, or no irrigation. Methods: The authors retrospectively reviewed consecutive patients undergoing all types of breast reconstruction with implants at Rigshospitalet and Herlev Hospital, Denmark, from 2010 to 2019. Logistic regression was used to compare the risk of deep infection between no irrigation and irrigation with gentamicin or vancomycin, and to account for the difference in risk between patient subgroups and risk factors. Results: The authors included 1508 patients who received antibiotic irrigation with gentamicin (500 patients), vancomycin (304 patients), or no irrigation (704 patients). The univariable risk analysis showed a significant decreased risk of deep infection using gentamicin irrigation compared with no irrigation (OR, 0.58; P < 0.05). However, when adjusting for risk factors for infection, there was no significant decrease in the risk of infection when using gentamicin (OR, 0.90; P = 0.71) or vancomycin (OR, 1.0; P = 0.99) compared with the control group. Conclusions: The authors found no significant effect of using antibiotic implant irrigation after isolating it from risk factors for deep infection. However, because of the limitations of the study, the authors cannot conclude that there is no effect of antibiotic implant irrigation. There is a need for a randomized, placebo-controlled trial to investigate the effect, and potential side-effects, of antibiotic implant irrigation. Clinical Question/level of Evidence: Risk, II. (Copyright © 2023 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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