American Association of Plastic Surgeons

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Alpha Defensin-1 Level Correlates with Peri-prosthetic Infection Severity following Implant-based Breast Reconstruction
Nikhil Sobti, MD, Neel Vishwanath, BS, Thor Stead, BS, Vinay Rao, MD, MPH, Luke Soliman, MTS, Karl Breuing, MD, Daniel Kwan, MD, Paul Liu, MD, Scott Schmidt, MD, MBA
The Warren Alpert Medical School of Brown University, Providence, RI, USA

PURPOSE:
Accurate diagnosis of peri-prosthetic infection severity following breast reconstruction is imperative to guide management. Qualitative analysis of alpha-defensin-1 (AD-1), an antimicrobial peptide released by neutrophils in response to active infection, has proven to be both sensitive and specific for the identification breast implant infection. We hypothesize that quantitative levels of AD-1 within peri-implant fluid samples may correlate with severity of infection.
METHODS:
Prospective evaluation of patients with implant-based breast reconstruction undergoing revision (exchange versus explantation) between June 2018-June 2019 was conducted. Peri-prosthetic fluid was sampled and sent for quantitative AD-1 analysis. Each breast was assigned an infection severity. Ordinal logistic regression was performed to evaluate the correlation between infection severity and AD-1 level.
RESULTS:
Twenty-nine patients met inclusion criteria, resulting in a total of 38 breasts sampled. Fifteen breasts (38.4%) were found to have peri-prosthetic infection. Infected breast samples demonstrated significantly higher quantitative AD-1 levels (3.90 vs 0.14, p<0.01). Increasing quantitative AD-1 demonstrated significantly greater odds of erythema (p=0.01), purulence (p=0.01), fever (p=0.01), threatened exposure (p<0.01), and implant exposure (p=0.04). Ordinal logistic regression analysis demonstrated that quantitative AD-1 level was an independent predictor of infection severity (χ=22.77, p<0.01), with an increase in infection score by 1.20 for every one-unit increase in AD-1.
CONCLUSION:
AD-1 levels correlate with peri-prosthetic infection severity, highlighting its potential to overcome limitations in standard bacterial culture, which may further guide development of an infection scoring system and novel implant salvage algorithm for patients undergoing prosthesis-based breast reconstruction.


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