Do Postoperative Prophylactic Antibiotics Reduce Highly Virulent Infections?
| Autor: | Phoebe McAuliffe, Jason C. Ganz, Kailash Kapadia, William Marmor, Austin Ferrier, Hunter Rogoff, Alexander B. Dagum, Christopher Medrano, Jocellie Marquez, Duc T. Bui, Tara L. Huston, Kanad Ghosh, Kaitlin Monroig, Sami U. Khan |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
biology Pseudomonas aeruginosa business.industry medicine.drug_class Antibiotics Perioperative 030230 surgery medicine.disease_cause biology.organism_classification Acinetobacter baumannii 03 medical and health sciences 0302 clinical medicine Staphylococcus aureus 030220 oncology & carcinogenesis Internal medicine medicine Surgery Implant Antibiotic prophylaxis business Enterococcus faecium |
| Zdroj: | Annals of Plastic Surgery. 85:S50-S53 |
| ISSN: | 1536-3708 0148-7043 |
| Popis: | Background Many surgeons are reluctant to discontinue prophylactic antibiotics after 24 hours in tissue expander breast reconstruction (TEBR) because of fear of increased risk of surgical site infection (SSI). Currently, there is no consensus regarding antibiotic prophylaxis duration in TEBR. In addition, there remains a lack of research investigating microorganisms involved in SSI across various perioperative antibiotic protocols. The purpose of this study was to examine how 2 different prophylactic antibiotic regimens impacted the bacterial profiles of SSI and rate of implant loss after TEBR. Methods A single-institution retrospective review of immediate TEBRs between 2001 and 2018 was performed. Surgical site infections requiring hospitalization before stage 2 were included. Highly virulent organisms were defined as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species). Implant loss was defined as removal of tissue expander without immediate replacement. Results Of 660 TEBRs, 85 (12.9%) developed an SSI requiring hospitalization before stage 2. Fifty-six (65.9%) received less than 24 hours of perioperative intravenous antibiotics and oral antibiotics after discharge (group 1), and 29 (34.1%) received less than 24 hours of intravenous antibiotics only (group 2). There was no significant difference in demographics, preoperative chemotherapy/radiation, acellular dermal matrix usage, or treatment of SSI between groups. In group 1, 64% (n = 36) developed culture positive SSIs, compared with 83% (n = 24) in group 2 (P = 0.076). Staphylococcus aureus was the most common bacteria in both groups. Group 2 demonstrated a significantly increased incidence of gram-positive organisms (46.4% vs 72.4%, P = 0.022) and S. aureus (21.4% vs 55.2%, P = 0.002). However, there was no significant difference in overall highly virulent (P = 0.168), gram-negative (P = 0.416), or total isolated organisms (P = 0.192). Implant loss between groups 1 and 2 (62.5% vs 62.1%, P = 0.969) respectively, was nearly identical. Conclusions Our study demonstrates that, despite differences in bacterial profiles between 2 antibiotic protocols, prolonged postoperative antibiotic use did not protect against overall highly virulent infections or implant loss. Antibiotic stewardship guidelines against the overuse of prolonged prophylactic regimens should be considered. Further analysis regarding timing of SSIs and antibiotic treatment is warranted. |
| Databáze: | OpenAIRE |
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