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Locally Applied Single-dose Antibiotic Prophylaxis For Implant-based Breast Reconstruction: Pharmacokinetic Evaluation Of The Duration Of Effect
Mathilde N. Hemmingsen, MD1, Anne K. Bennedsen, MD
1, Randa B. Kullab, BMSc
1, Caroline B. Norlin, BMSc
1, Mathias Ørholt, MD
1, Andreas Larsen, MD
1, Mats Bue, MD
2, Mads Lichtenberg, MDc
3, Frederik B. Hertz, MD
1, Tine E. Damsgaard, MD
1, Peter Vester-Glowinski, MD
1, Søren J. Sørensen, MSc
3, Thomas Bjarnsholt, MSc
3, Mikkel Hery, MD
1;
1Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,
2Aarhus University Hospital, Aarhus, Denmark,
3University of Copenhagen, Copenhagen, Denmark
PURPOSE: Antibiotic irrigation of breast implants is widely used internationally, but no clinical study has investigated the pharmacokinetics in the breast implant pocket. In this prospective study, we determine how long locally applied gentamicin, cefazolin, and vancomycin maintain concentrations in the implant pocket above the minimum inhibitory concentration (MIC) for common infective bacteria and measure systemic uptake.
METHODS: Patients undergoing implant-based breast reconstruction were recruited from the ongoing BREAST-AB trial, in which they were randomized to implant- and pocket irrigation with 160 µg/mL gentamicin, 2000 µg/mL cefazolin, and 2000 µg/mL vancomycin in a 200 mL saline solution or placebo at Rigshospitalet, Denmark. Samples from the breast drain and blood were obtained up to 10 days postoperatively.
RESULTS: We included 40 patients who contributed with 146 drain samples and 66 blood samples between October 2021 and September 2022. Vancomycin and cefazolin remained above the MIC for
S aureus significantly longer than gentamicin (gentamicin: 0.9 days versus vancomycin: 6.9 days,
P<0.05, and cefazolin: 3.7 days,
P<0.01). Gentamicin remained above the MIC for
Pseudomonas aeruginosa for 1.3 days. Only cefazolin was detectable in blood samples, albeit in very low concentrations (median: 0.04 µg/mL).
CONCLUSION: This study indicates that patients treated with triple-antibiotic implant irrigation during breast reconstruction receive adequate prophylaxis for
S aureus and other common implant-associated gram-positive bacteria. However, the protection against
P aeruginosa may be inadequate.
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