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Extended Postoperative Antibiotic Prophylaxis to Prevent Breast Implant Infections in the Irradiated Chest Wall
Michael N. Mirzabeigi, MSIV, Michelle Lee, MD, James M. Smartt, MD, Shareef Jandali, MD, Seema Sonnad, MD, Joseph M. Serletti, MD FACS.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: The implant-based approach remains as a prevalent means to reconstruct the breast mound. While radiation therapy for these patients has tremendous oncologic benefit, this population can be particularly challenging candidates for implant reconstruction due to troublesome rates of complications. Capsular contracture, impaired wound healing, and implant infection rates are all known to be exacerbated by chest wall irradiation. The issue of antibiotic prophylaxis remains controversial, and evidence-based postoperative strategies to reduce implant infections have not been well-described in the literature. The purpose of this study is to determine the efficacy of long term trimethoprim & sulfamethoxazole (TMP/SMX) therapy in preventing late implant infections in the radiated chest wall.
METHODS: A retrospective chart review of hospital and office records was performed on all patients undergoing implant reconstruction by a single surgeon [J.M.S.] from January 2005 to December 2008. Patients with previous radiation therapy to the chest wall and subsequent implant breast reconstruction were included. It was well known to the examiners that prior to 2007, the senior author commonly utilized short term (5-7 days) first generation cephalosporin antibiotic prophylaxis for implant reconstructions. Subsequent to this time period, the postoperative prophylactic regimen was amended as to provide all patients with previous chest wall irradiation and implant reconstruction with prophylactic TMP/SMX for 30 days following implant insertion. The outcome variable was implant infection, and statistical analysis included Chi-Squared Analysis and Kaplan Meier Estimator.
RESULTS: A total of 51 post-radiation implant reconstructions were performed on 46 patients. The study population was divided into 2 groups: 26 implant reconstructions without extended TMP/SMX prophylaxis (control group) and 25 implant reconstructions with 30 days of TMP/SMX prophylaxis (TMP/SMX group). The control group had an implant infection rate of 35 percent as compared to 8 percent for the TMP/SMX group (p = 0.021). The control group was subdivided into 2 groups: 19 implant reconstructions received 5-7 days of cephalosporin prophylaxis (routine antibiotics group) and 7 implant reconstructions received no postoperative prophylaxis (no antibiotics group). The routine antibiotics group had an infection rate of 42 percent as compared to 8 percent for the TMP/SMX group (p = 0.0075).
CONCLUSION: A month-long course of TMP/SMX was proven to be more effective than routine perioperative antibiotics in preventing implant infections. Extended TMP/SMX therapy serves as an effective adjunctive measure for reducing the rate of implant infections in breast reconstruction.
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