George M Viola1, Issam I Raad, Kenneth V Rolston. 1. Division of Medicine, Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
OBJECTIVE: The rate of postmastectomy tissue expander (TE) infection remains excessively high, ranging between 2% and 24%. We hypothesized that current perioperative antimicrobial regimens utilized for breast TE reconstruction may be outdated as a result of recent changes in microflora and susceptibility patterns. DESIGN AND METHODS: We reviewed the records of all patients who had a TE reconstructive procedure and developed a definite breast TE infection between 2003 and 2010 at MD Anderson Cancer Center. Antimicrobials were stratified into 3 groups: systemic perioperative, local irrigation, and oral immediate postoperative antimicrobials. These were considered discordant if they did not target the isolated organisms, while a breakthrough infection was defined as an infection that occurred despite concordant antimicrobial coverage. RESULTS: Overall, 75 patients with a definite TE infection were identified. The most common organisms identified were methicillin-resistant Staphylococcus epidermidis (29%), methicillin-resistant Staphylococcus aureus (15%), and gram-negative rods (26%). The use of systemic perioperative antimicrobials was deemed discordant in 51% of the cases. Although 79% of the patients received broad-spectrum perioperative local antimicrobial irrigation, 63% developed a breakthrough infection. Even though 61% received oral postoperative prophylactic antimicrobials, 63% of the times they were deemed discordant. CONCLUSIONS: Contrary to the proven effectiveness of a single dose of perioperative antibiotics, the common use of local antimicrobial irrigation and prolonged postoperative oral antibiotics appears to be an inadequate component of our preventive armamentarium. Also, because methicillin-resistant staphylococcal and pseudomonal infections occurred approximately 60% of the time, at institutions that have observed an increase of these organisms, it may be prudent that perioperative antimicrobials target these microorganisms.
OBJECTIVE: The rate of postmastectomy tissue expander (TE) infection remains excessively high, ranging between 2% and 24%. We hypothesized that current perioperative antimicrobial regimens utilized for breast TE reconstruction may be outdated as a result of recent changes in microflora and susceptibility patterns. DESIGN AND METHODS: We reviewed the records of all patients who had a TE reconstructive procedure and developed a definite breast TE infection between 2003 and 2010 at MD Anderson Cancer Center. Antimicrobials were stratified into 3 groups: systemic perioperative, local irrigation, and oral immediate postoperative antimicrobials. These were considered discordant if they did not target the isolated organisms, while a breakthrough infection was defined as an infection that occurred despite concordant antimicrobial coverage. RESULTS: Overall, 75 patients with a definite TE infection were identified. The most common organisms identified were methicillin-resistant Staphylococcus epidermidis (29%), methicillin-resistant Staphylococcus aureus (15%), and gram-negative rods (26%). The use of systemic perioperative antimicrobials was deemed discordant in 51% of the cases. Although 79% of the patients received broad-spectrum perioperative local antimicrobial irrigation, 63% developed a breakthrough infection. Even though 61% received oral postoperative prophylactic antimicrobials, 63% of the times they were deemed discordant. CONCLUSIONS: Contrary to the proven effectiveness of a single dose of perioperative antibiotics, the common use of local antimicrobial irrigation and prolonged postoperative oral antibiotics appears to be an inadequate component of our preventive armamentarium. Also, because methicillin-resistant staphylococcal and pseudomonal infections occurred approximately 60% of the time, at institutions that have observed an increase of these organisms, it may be prudent that perioperative antimicrobials target these microorganisms.
Authors: George M Viola; Jesse C Selber; Melissa Crosby; Issam I Raad; Charles E Butler; Mark T Villa; Steven J Kronowitz; Mark W Clemens; Patrick Garvey; Wei Yang; Donald P Baumann Journal: Plast Reconstr Surg Glob Open Date: 2016-06-10
Authors: Joel Rosenblatt; Ruth A Reitzel; George M Viola; Nylev Vargas-Cruz; Jesse Selber; Issam Raad Journal: Biomed Res Int Date: 2017-11-07 Impact factor: 3.411
Authors: George M Viola; Donald P Baumann; Kriti Mohan; Jesse Selber; Patrick Garvey; Gregory Reece; Issam I Raad; Kenneth V Rolston; Melissa A Crosby Journal: Plast Reconstr Surg Glob Open Date: 2016-05-06
Authors: Ashley O Frois; Patrick O Harbour; Farhad Azimi; Jane Young; Belinda Chan; Cindy Mak; Sanjay Warrier Journal: Plast Reconstr Surg Glob Open Date: 2018-09-14
Authors: Ainslie Lavers; Wai Siong Yip; Bruce Sunderland; Richard Parsons; Sarah Mackenzie; Jason Seet; Petra Czarniak Journal: PeerJ Date: 2018-10-23 Impact factor: 2.984