Prolonged Postoperative Antibiotic Research Articles

Outcome differences of emergency cesarean delivery in the delivery room versus the operating room: A study based on propensity score matching.

This study sought to compare the risks and outcomes associated with category I cesarean section procedures performed in the delivery room versus those performed in the operating room. The analysis included 126 singleton pregnant women who underwent inpatient delivery at the Second People's Hospital of Nanning between January 2021 and May 2024. Following propensity score matching, 21 cases were in the delivery room group, and 105 cases were in the operating room group. Parameters under investigation encompassed decision-to-delivery interval, incision-to-delivery interval, surgical duration, intraoperative blood loss, postoperative antibiotic duration, postoperative hospital stay length, postoperative fever incidence, adverse neonatal outcomes, and blood routine parameters. The decision-to-delivery interval was significantly shorter in the delivery room group than in the operating room group. Conversely, the delivery room group exhibited longer surgical durations, higher blood loss, prolonged postoperative antibiotic usage, extended hospital stays, and elevated white blood cell counts with statistical significance (p < 0.05). Nevertheless, no notable variations were observed between the groups in maternal and neonatal outcome indicators, such as adverse neonatal outcomes and postoperative fever rates. The outcomes suggest that the delivery room group showed increased risks compared with the operating room group, potentially indicating heightened vulnerabilities to bleeding and infection. Hence, it is advisable for patients to undergo surgery in the operating room unless the delivery room is equipped with sterile surgical facilities or in cases of urgent necessity.

The outcome of prolonged postoperative antibiotics on wound healing in orthognathic surgery: A meta-analysis.

We conducted a meta-analysis to assess the outcome of prolonged postoperative antibiotics (PA) on wound healing in orthognathic surgery (OS). A systematic literature search up to January 2023 was performed and 1021 related studies were evaluated. The chosen studies comprised 1057 OS subjects who participated in the selected studies' baseline, 446 of them used short-term PA, and 611 used long-term PA. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of prolonged PA on wound infection after OS by the dichotomous methods with a random or fixed effect model. The short-term PA resulted in significantly higher wound infection (OR, 4.27; 95% CI, 2.97-6.14, P< 0.001) with low heterogeneity (I2 = 27%) compared to the long-term PA in OS. The short-term PA resulted in significantly higher wound infection compared to the long-term PA in OS. Though care should be taken when dealing with the results since a large number of the selected studies had <100 subjects as a sample size.

Adverse financial and clinical burden of the use of prophylactic antibiotics in neurosurgical patients

BackgroundCurrent guidance does not support the administration of prophylactic antibiotics in non-infected post-operative surgical cases including neurosurgery. Materials and methodsThis paper is a qualitative assessment, highlighting the economic cost of excessive antimicrobial prescription and the healthcare costs of the extra days of admission in hospital. ResultsOne hundred and one neurosurgical cases were analysed in a single institution over a one-year period. The additional course of post-operative antibiotics has a cost of £56.72 and receiving prolonged post-operative antibiotics added on average £1121.10 to their admission bill. Up to 13.4 patients may have experienced an adverse drug event. ConclusionThis paper reinforces the adherence to guidelines can aid in the reduction of adverse drug events, improve patient outcomes, and reduce costs associated with unnecessary drug prescriptions and administration.

Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty.

Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication of hip or knee joint arthroplasty. The experience for outcomes of NTMPJI treatment is still limited. The objective of this study was to investigate the outcome of hip or knee nontuberculous mycobacteria periprosthetic joint infection following treatment with two-stage exchange arthroplasty. From 1995 to 2020, 12 patients with NTMPJI were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidity, microbiological data, treatment outcome and antibiotic formula in bone cement. Mycobacterium abcessus (n = 6) and Mycobacterium chelonae (n = 2) constitute the majority of the cases. Five patients had early-onset PJIs and the other seven patients were late onset. The success rate of two-stage exchange arthroplasty was 66.7% (8 of 12). Three patients experienced infection relapse, and one patient had soft tissue compromise complication. Post-operative antibiotic therapy may not improve the success rate (4 of 6 cases, 66.7%). Based on in vitro study, the most commonly used effective antibiotic in bone cement spacer for nontuberculous mycobacteria was amikacin. nontuberculous mycobacteria is a rare cause of PJIs and should be suspected especially in relatively immunocompromised patients. Resection arthroplasty with staged reimplantation is the preferred approach. Prolonged post-operative antibiotic therapy before reimplantation may not improve the success rate. Delayed revision surgery may not be needed and can be performed once C-reactive protein level is normal after a drug holiday.

Treatment outcomes of patients with Cutibacterium acnes-positive cultures during total joint replacement revision surgery: a minimum 2-year follow-up

IntroductionPeriprosthetic joint infection (PJI) is a devastating complication following total joint replacement (TJR). Cutibacterium acnes (C. acnes) is a low virulent skin commensal, commonly found during TJR revision surgery for “aseptic” causes. The purpose of the present study was to report the treatment outcomes of patients with C. acnes contamination or infection in the presence of a TJR treated with a revision surgery ± implant exchange ± prolonged (≥ 8 weeks) postoperative antibiotics.MethodsMedical records of patients with at least one positive C. acnes culture in intraoperative tissue samples or sonication fluid from a TJR revision surgery between January 2005 and December 2014 were retrospectively evaluated. The primary endpoint was infection eradication according to Delphi criteria. The diagnostic accuracy of preoperative TJR aspiration regarding the diagnosis of C. acnes PJI was also investigated.ResultsA total of 52 TJR (28 shoulders, 17 hips, 7 knees) in 52 patients (35 males, 17 females) with an average age of 63 ± 11 (33–86) years were included. At an average follow-up of 67 ± 33 (24–127) months, the infection eradication of C. acnes PJI was 97% regardless of the surgical treatment or administration of prolonged postoperative antibiotics. The incidence of unsuspected C. acnes PJI was 28.8%. The sensitivity and specificity of preoperative joint aspiration in detecting C. acnes PJI were 59% and 88%, whereas the PPV and NNV were 83% and 67%, respectively.ConclusionInfection eradication of C. acnes PJI was very high at a minimum follow-up of 24 months, suggesting that C. acnes PJI could be adequately treated with a combination of revision surgery and prolonged postoperative antibiotics. The preoperative diagnosis of C. acnes PJI might be challenging with more than one-quarter of patients presenting without suspicion of C. acnes PJI. The appropriate treatment of patients with a single positive culture remains still unclear. A negative TJR aspiration should not rule out a C. acnes PJI, especially in the presence of clinical correlates of infection.Level of evidenceRetrospective case–control study, Level III.IRB approvalKantonale Ethikkommission Zürich, BASEC Nr.:2017-00567.

Analysis of postoperative complications following elective arthroscopic surgeries of the knee- a retrospective cohort study

BackgroundSince their introduction, arthroscopic procedures have been increasingly utilized for the treatment of knee pathologies, especially Anterior Cruciate Ligament (ACL) reconstruction. Reduction of post-operative morbidity, shortened hospital stay and recovery period have all been identified as the benefits of arthroscopy. However, despite tremendous increase in the number of these procedures done, the postoperative complications associated have been infrequently analyzed. Hence, we performed this study to analyze the perioperative complications of arthroscopic ACL reconstruction. Materials & methodsWe performed a retrospective case control study from our hospital database from the cases performed in July 2015 to December 2016. We included 20 cases who developed postoperative complications within 30 days of the procedure and 60 controls operated during the same period who did not have any complications. ResultsThe complications noted in the cases were surgical site infection (SSI), deep vein thrombosis (DVT), effusion and superficial infection. The risk factors associated with each complication were compared with the cases and analyzed. ConclusionsIt was found that the lack of specialist physiotherapy, surgical prophylaxis and prolonged postoperative antibiotics were the major risk factors in the development of complications among our patients who underwent arthroscopic ACL reconstruction.

Minimizing Antibiotic Use in Urethral Reconstruction.

There are no established guidelines regarding management of antibiotics for patients specifically undergoing urethral reconstruction. Our aim was to minimize antibiotic use by following a standardized protocol in the pre-, peri- and postoperative setting, and adhere to American Urological Association antibiotic guidelines. We hypothesized that prolonged suppressive antibiotics post-urethroplasty does not prevent urinary tract infection and/or wound infection rates. We prospectively treated 900 patients undergoing urethroplasty or perineal urethrostomy at 11 centers over 2 years. The first-year cohort A received prolonged postoperative antibiotics. Year 2, cohort B, did not receive prolonged antibiotics. A standardized protocol following the American Urological Association guidelines for perioperative antibiotics was used. The 30-day postoperative infectious complications were determined. We used chi-square analysis to compare the cohorts, and multivariate logistic regression to identify risk factors. The mean age of participants in both cohorts was 49.7 years old and the average stricture length was 4.09 cm. Overall, the rate of postoperative urinary tract infection and wound infection within 30 days was 5.1% (6.7% in phase 1 vs 3.9% in phase 2, p=0.064) and 3.9% (4.1% in phase 1 vs 3.7% in phase 2, p=0.772), respectively. Multivariate logistic regression analysis of patient characteristics and operative factors did not reveal any factors predictive of postoperative infections. The use of a standardized protocol minimized antibiotic use and demonstrated no benefit to prolonged antibiotic use. There were no identifiable risk factors when considering surgical characteristics. Given the concern of antibiotic over-prescription, we do not recommend prolonged antibiotic use after urethral reconstruction.

APOS\u2014antibiotic prophylaxis for preventing infectious complications in orthognathic surgery: study protocol for a phase III, multicentre, randomised, controlled, double blinded, clinical trial with two parallel study arms

BackgroundIt is a constant debate among surgeons whether the use of prolonged postoperative antibiotics may reduce surgical site infection rates. As specific treatment guidelines are still lacking, many surgeons continue to use broad-spectrum antibiotics, causing not only increased costs but also contributing to the potential for antibiotic resistance. Hence, there is an urgent need for an appropriately designed prospective clinical trial, to investigate whether a prophylactic use of antibiotics after surgery actually decreases surgical site infections to a clinically relevant degree.MethodsThis study presents a multicentre, randomised, controlled, double-blinded, clinical trial with two parallel study arms to demonstrate that no postoperative antibiotic prophylaxis (AP) is not inferior to antibiotic prophylaxis with respect to surgical site infections in patients having undergone orthognathic surgery. The primary efficacy endpoint is defined as the occurrence of postoperative surgical site infections within 30 days of surgery. Secondary endpoints are further efficacy and subject-oriented parameters within 90 days after surgery. The entire trial is planned for 54 months, with an enrolment of 1420 patients over 39 months by 14 national participating centres.DiscussionAs a highly standardised procedure on an exceeding, healthy and young homogenous study population and identical processes all over the world, elective orthognathic surgery as clean-contaminated procedure provides comparable intervention groups with balanced baseline characteristics, comparable surgical duration, even when performed within multiple centres. Therefore, evaluating antibiotic prophylaxis after orthognathic surgery will be of high scientific value representable for other surgical procedures.Trial registrationDRKS—German Clinical Trials Register—DRKS00022838; EudraCT No. 2020-001397-30. Registered on 29 March 2021

Comparision of Infection Frequency in 1-Day Vs 5-Days Post Operative Antibiotic Regimen in Open Treated Facial Fractures

Objective: To compare the frequency of surgical site infection by using postoperative prophylactic antibiotics (1day vs. &gt; 5 days) in patients following open surgical reduction of facial fractures. Design: Randomized Controlled Trial Setting: Department of Dental &amp;Maxillofacial Surgery, Liaquat National Hospital, Institute of Postgraduate Medical Studies &amp; Health Sciences, Karachi. Duration: 06months from 23 December 2016 to 22 June 2017. Subject and Methods: A total of 368 cases according to inclusion and exclusion criteria were included in this study. Patients were randomly divided into two groups. Antibiotic (Inj. Augmentin 1.2g) was given to group A from admission to 24 hours postoperatively and in Group B antibiotic was continue up to 05 days postoperatively. A surgeon evaluated participants of both groups at 1, 2, 3 and 4 weeks postoperatively for infection according to criteria of surgical site infection published by CDC. All information was noted in the proforma. Results: - The average age of the patients was 31.10±7.39 years. Rate of surgical site infection was not significant between groups (4.9% vs. 7.1%; p=0.379). Conclusion: In this study 1-day course of antibiotics postoperatively in facial fractures is as effective in preventing infective complications as a 5-day regimen. The use of prolonged postoperative antibiotics in uncomplicated facial fractures had no significant benefit in reducing the incidence of infections. Key Words: Maxillofacial Surgeons, Surgical site infection, Prophylactic antibiotics

MP35-07 ANTIBIOTIC USAGE IN URETHROPLASTIES

INTRODUCTION AND OBJECTIVE: There are no established guidelines regarding management of antibiotics for patients specifically undergoing urethroplasty, which has resulted in significant variation in practice with type, duration, and timing of antibiotic usage. Our aim was to minimize antibiotic use by following a standardized protocol in the pre, peri and post-operative setting and adhere to AUA antibiotic guidelines for urethroplasty. We hypothesized that the common practice of prolonged suppressive antibiotics post urethroplasty does not prevent UTI and/or wound infection rates. METHODS: We prospectively treated 900 patients undergoing urethroplasty at 11 centers over 2 years. A standardized protocol followed the AUA guidelines recommendation for peri-operative cephalosporins eliminating the over use of more board spectrum antibiotics. Phase 1 of our study assessed current practice patterns amongst surgeons in the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) and established a baseline UTI and wound infection rates on suppressive antibiotics. Phase 2 eliminated prolonged post-operative suppressive antibiotics. Antibiotics were given at catheter removal. 30-day infectious complications were determined and a chi-square analysis was used to compare the two cohorts. A standardized definition of UTI and wound infection was utilized. Multivariate logistic regression was performed to identify risk factors. RESULTS: The mean age of participants in both cohorts was 49.7 years old, mean BMI was 30.8, and the average stricture length was 4.09 cm. Overall, the rate of postoperative UTI and wound infection within 30 days was 5.1% (6.7% in phase 1 vs 3.9% in phase 2 (p=0.064), and 3.9%, (4.1% vs 3.7% p=0.772) respectively. After comparing several patient factors including comorbidities, location of stricture, and graft use, only preoperative UTI was a significant predictor of postoperative UTI (p=0.043). No characteristic was significant for wound infections. CONCLUSIONS: The usage of prolonged postoperative antibiotics did not decrease postoperative UTI or wound infection rates. A standardized protocol minimized antibiotic use in the pre, peri and post-operative setting. Given the worldwide crisis of antibiotic overuse, standardized protocols can minimize antibiotic use in urethral reconstruction and post-operative suppressive antibiotics can be eliminated. Source of Funding: none

To Compare the Effectiveness of Short-term Three Dose Perioperative Antibiotic Coverage during Decisive Period with Conventional Prolonged Postoperative Antibiotic Usage in Clean Elective Surgical Cases: An Indian Perspective.

Background:Surgical site infections are the most common postoperative complications and frequently cause morbidity and mortality. Different antibiotic regimens were evaluated as prophylaxis in wound infection following elective surgical procedures. Prophylactic antibiotics should be given to cover the “decisive period” which is a period after incision to mobilization of host defenses thus preventing an infection from developing.Objectives:The aim is to study the effectiveness of short-term antibiotic coverage during decisive period in the prevention of postoperative wound sepsis in clean surgical cases.Materials and Methods:The prospective randomized comparative study included 50 patients divided into two groups of 25 each. Group A (short-term ceftriaxone prophylaxis) patients received three doses of 1 g intravenous ceftriaxone. First dose 12 h, 2nd dose 1 h before operation and the 3rd dose was given 10 h after the operation. The Group B (conventional postoperative ceftriaxone prophylaxis) patients received postoperatively 1 g B. D intravenous ceftriaxone for 5 days. We compared the incidence of surgical site infection in two groups.Study Period:November 2014 to September 2016. A predesigned and pretested proforma was used to collect the data. Surgical sites were examined for 30 days. Robertson grading was used to assess the severity of infection.Results:Surgical site infection rate was 4% in Group A and 24% in Group B. The severity of infection was less in short-term prophylaxis group. Anemia, nutritional status, and use of drain were other factors associated with postoperative wound infections.Conclusion:Short course perioperative (three doses) ceftriaxone prophylaxis is sufficient in preventing wound infection. Prophylactic antibiotic should be given to cover the decisive period to prevent an infection from developing. The judicious use of antibiotics can reduce the cost, unnecessary prolonged exposure, side effects, and the emergence of resistant micro-organisms.

A Prolonged Post-Operative Antibiotic Regimen Reduced the Rate of Prosthetic Joint Infection after Aseptic Revision Knee Arthroplasty.

The aim of this study was to compare the prosthetic joint infection (PJI) rate after knee revision arthroplasty in two consecutive periods with different antibiotic prophylaxis: short (one day) versus long (five days). From January 2007 to September 2010 antibiotic prophylaxis consisted of 800 mg of teicoplanin and 2 g of ceftazidime intravenously and 1 g of ceftazidime two hours after the first dose. From October 2010, it was prolonged post-operatively using vancomycin and ceftazidime intravenously until the fifth day. During the study period, 341 revision surgeries met the inclusion criteria. The PJI rate was lower in the long-prophylaxis group (2.2% versus 6.9%, p=0.049). Prolonged post-operative antibiotic treatment was the only variable associated independently with a lower rate of PJI (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.07-0.99).

Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction.

Although some surgeons prescribe prolonged postoperative antibiotics after autologous breast reconstruction, evidence is lacking to support this practice. We used the Tracking Operations and Outcomes for Plastic Surgeons database to evaluate the association between postoperative antibiotic duration and the rate of surgical site infection (SSI) in autologous breast reconstruction. The intervention of interest for this study was postoperative duration of antibiotic prophylaxis: either discontinued 24 hours after surgery or continued beyond 24 hours. The primary outcome variable of interest for this study was the presence of SSI within 30 days of autologous breast reconstruction. Cohort characteristics and 30-day outcomes were compared using χ² and Fischer exact tests for categorical variables and Student t tests for continuous variables. Multivariate logistic regression was used to control for confounders. A total of 1036 patients met inclusion criteria for our study. Six hundred fifty-nine patients (63.6%) received antibiotics for 24 hours postoperatively, and 377 patients (36.4%) received antibiotics for greater than 24 hours. The rate of SSI did not differ significantly between patients given antibiotics for only 24 hours and those continued on antibiotics beyond the 24-hour postoperative time period (5.01% vs 2.92%, P = 0.109). Furthermore, antibiotic duration was not predictive of SSI in multivariate regression modeling. We did not find a statistically significant difference in the rate of SSI in patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours. These findings held for both purely autologous reconstruction as well as latissimus dorsi reconstruction in conjunction with an implant. Thus, our study does not support continuation of postoperative antibiotics beyond 24 hours after autologous breast reconstruction.

Anterolateral Papillary Muscle Rupture Caused by Brucella Endocarditis

Introduction: Brucellosis is a common zoonosis in Iran, transmitted to humans by direct contact with infected animal materials like fleece, animal excrement, leather, butchery or by the consumption of contaminated animal products (e.g. fresh cheese, unpasteurized milk or dairy products, and raw meat and raw liver that is consumed semi-roasted by kebab sellers in Iran. Case Presentation: A 21-year-old woman presented with respiratory failure due to pulmonary edema from severe acute mitral valve regurgitation in the setting of acute Brucella endocarditis. She was found to have a ruptured anterolateral papillary muscle from necrosis caused by corroding large vegetations on the anterior mitral valve leaflet. Conclusions: This occurrence is an exceptionally rare phenomenon, in Brucella mitral endocarditis. Urgent transesophageal echocardiography (TEE) revealed large mobile vegetation on the anterior papillary muscle with severe mitral valve regurgitation. The patient underwent mitral valve replacement. During valve replacement surgery, anterior mitral valve vegetation and rupture of the AL-PM were confirmed. We also considered that prolonged post-operative antibiotic treatment was indicated in our patient to protect the newly implanted prosthetic valves.

Anterolateral Papillary Muscle Rupture Caused by Brucella Endocarditis

Introduction:: Brucellosis is a common zoonosis in Iran, transmitted to humans by direct contact with infected animal materials like fleece, animal excrement, leather, butchery or by the consumption of contaminated animal products (e.g. fresh cheese, unpasteurized milk or dairy products, and raw meat and raw liver that is consumed semi-roasted by kebab sellers in Iran. Case Presentation:: A 21-year-old woman presented with respiratory failure due to pulmonary edema from severe acute mitral valve regurgitation in the setting of acute Brucella endocarditis. She was found to have a ruptured anterolateral papillary muscle from necrosis caused by corroding large vegetations on the anterior mitral valve leaflet. Conclusions:: This occurrence is an exceptionally rare phenomenon, in Brucella mitral endocarditis. Urgent transesophageal echocardiography (TEE) revealed large mobile vegetation on the anterior papillary muscle with severe mitral valve regurgitation. The patient underwent mitral valve replacement. During valve replacement surgery, anterior mitral valve vegetation and rupture of the AL-PM were confirmed. We also considered that prolonged post-operative antibiotic treatment was indicated in our patient to protect the newly implanted prosthetic valves.

A positive bacterial culture from allograft bone at implantation does not correlate with subsequent surgical site infection.

Fresh-frozen allograft bone is frequently used in orthopaedic surgery. We investigated the incidence of allograft-related infection and analysed the outcomes of recipients of bacterial culture-positive allografts from our single-institute bone bank during bone transplantation. The fresh-frozen allografts were harvested in a strict sterile environment during total joint arthroplasty surgery and immediately stored in a freezer at -78º to -68º C after packing. Between January 2007 and December 2012, 2024 patients received 2083 allografts with a minimum of 12 months of follow-up. The overall allograft-associated infection rate was 1.2% (24/2024). Swab cultures of 2083 allografts taken before implantation revealed 21 (1.0%) positive findings. The 21 recipients were given various antibiotics at the individual orthopaedic surgeon's discretion. At the latest follow-up, none of these 21 recipients displayed clinical signs of infection following treatment. Based on these findings, we conclude that an incidental positive culture finding for allografts does not correlate with subsequent surgical site infection. Additional prolonged post-operative antibiotic therapy may not be necessary for recipients of fresh-frozen bone allograft with positive culture findings.

Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction

BackgroundAlthough some surgeons prescribe prolonged postoperative antibiotics after autologous breast reconstruction, evidence is lacking to support this practice. We used the Tracking Operations and Outcomes for Plastic Surgeons database to evaluate the association between postoperative antibiotic

Gonococcal ascending aortic aneurysm with penetrating ulcer and bovine arch

We describe a patient with ascending aorta aneurysm and bovine aortic arch who initially presented with fever. A 65-year-old man with a 2-month history of intermittent fever was referred to our hospital and diagnosed as having a gonococcal ascending aorta aneurysm with penetrating ulcers. He was successfully treated by resection of the ascending aorta and ulcers, replacement of the aortic valve, and prolonged postoperative antibiotic therapy.

The role of postoperative antibiotics in facial fractures

The goal of this study was to evaluate the influence of the duration of postoperative antibiotics (1 day vs. ≥ 5 days) on wound infections following surgical treatment of facial fractures. Three hundred thirty-nine patient case histories with a total of 498 fractures were reviewed retrospectively with regard to infections occurring within a 6-month period following surgical management. Patients were divided into two groups based on the duration of postoperative antibiotics administered. Group A consisted of 125 patients who had 1 day of postoperative antibiotics, whereas Group B consisted of 214 patients who had five or more days of postoperative antibiotics. Statistical analysis was conducted to assess for possible differences in the rate of postoperative infections. Five patients in Group A (4%) and seven patients in Group B (3.27%) developed infections within the follow-up period. Of these 12 patients, seven had sustained multiple facial bone fractures. Eleven infections occurred in patients with mandibular fractures and one in a midfacial fracture. Statistical analysis using Fisher's exact test showed no significant difference (p = 0.77) in the incidence of infection between Groups A and B. In this retrospective study, the use of prolonged postoperative antibiotics in uncomplicated mandibular and midfacial fractures had no significant benefit in reducing the incidence of infections. Therapeutic study, level IV.

A Successful Salvage Protocol for Breast Implants

Sir: Breast augmentation is the most common procedure in cosmetic surgery. For many years, the presence of infection in the setting of breast prostheses has necessitated implant removal and delayed reinsertion.1–5 Although successful salvage of prostheses in the presence of periprosthetic infections has been reported before, it is not a generally accepted practice. We review our experience with implant salvage in patients with periprosthetic infections following cosmetic breast surgery with implants for a 1-year period. The protocol included a “sequential cleaning,” an implant replacement, and prolonged postoperative antibiotics. Six patients, all with silicone cohesive gel prostheses, underwent implant salvage. Patients with periprosthetic infections were submitted to this protocol if they manifested the following criteria: clinical infection symptoms, no sign of sepsis (clinical and/or laboratorial), and implant exposure less than 48 hours. The risks involved in saving the implant were systematically clarified to the patients, as the procedure could be successful or not. Wound swabs from the pocket were sent for culture and sensitivity testing. The implant was removed. The sequential cleaning steps were as follows: The cavity of the capsule was scrubbed with chlorhexidine gluconate 2% scrub, and an abdominal swab wet with chlorhexidine alcohol 0.5% solution was left in the pocket for 5 minutes. The cavity of the capsule was scrubbed with abdominal swabs full of half-strength hydrogen peroxide, and an abdominal swab wet with half-strength hydrogen peroxide was left in the pocket for 5 minutes. The cavity was then irrigated with copious amounts of normal saline, approximately 2 liters. The cavity of the capsule was scrubbed with povidone-iodine surgical scrubs, an abdominal swab wet with povidone-iodine was left in the pocket for 5 minutes, and then a drain was positioned. Subsequently, a new implant was placed in the pocket and the scar was closed in four layers with nonabsorbable sutures. A solution consisting of 1.5 g of cefuroxime diluted with 18 ml of saline plus 80 mg of gentamicin (2-ml ampule) plus 40 ml of povidone-iodine was given through the drain. The drain was kept closed for 4 hours. Postoperatively, patients received intravenous antibiotics, 1.5 g cefuroxime (three times per day) plus gentamicin 120 mg (one dose) for 24 hours. Patients were discharged from the hospital without drains and with oral ciprofloxacin 500 mg (three times per day) for up to 10 days. The antibiotics should be adjusted according to the antibiogram result. The patients were followed closely for 8 months. Five of the patients had periprosthetic infections following simple primary breast enlargement, and one was associated with a mastopexy procedure. Of these six patients, Pseudomonas aeruginosa was isolated in one, Staphylococcus aureus was isolated in three, and mixed flora was isolated in two. All patients managed to keep their implants and, at more than 1-year follow-up, there were no signs of rejection or capsular contracture in any of the patients. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. Marcos Sforza, M.D. Dolan Park Hospital Bromsgrove, United Kingdom Katarina Andjelkov, M.D., Ph.D. University of Belgrade Belgrade, Serbia Renato Zaccheddu, M.D. Dolan Park Hospital Bromsgrove, United Kingdom