Topical Antibiotic Irrigation Research Articles

Efficacy of antibiotic prophylaxis for reducing capsular contracture in prosthesis-based breast surgery: a systemic review and meta-analysis.

Antibiotics Prophylaxis to prevent capsular contracture in prosthesis-based breast surgery is common in clinical practice. However, there is currently a dearth of high-quality evidence concerning the effectiveness of antibiotic usage in this field. To identify all pertinent studies prior to January 2023, a comprehensive literature search was conducted in the PubMed, Embase, Web of Science, Cochrane Library, and Medline databases. The extracted data was then subjected to meta-analysis. Fourteen studies were retained in the analysis. According to the results, perioperative antibiotic prophylaxis did not reduce the risk of capsular contracture (RR 1.15, 95% CI 0.82-1.59, p = 0.55) or surgical-site infection (RD 0.01, 95% CI - 0.01 to 0.03, p = 0.59) compared to nonantibiotic prophylaxis. There was no statistically significant difference between extended antibiotic prophylaxis and perioperative antibiotic prophylaxis in terms of preventing capsular contracture, whether calculated by patient numbers (RD 0.01, 95% CI - 0.01 to 0.02, p = 0.87) or by total procedures (RD 0.00, 95% CI - 0.00 to 0.01, p = 0.88), or controlling surgical-site infection (RR 1.05, 95% CI 0.77-1.44, p = 0.27). Additionally, topical antibiotic irrigation did not decrease the risk of infection (RR 0.61, 95% CI 0.34-1.08, p = 0.29) and capsular contracture, regardless of patient number (RR 0.41, 95% CI 0.27-0.63, p = 0.18) or total number of procedures (RR 1.29, 95% CI 0.73-2.28, p < 0.01). Current evidence revealed that both systemic and topical antibiotic prophylaxis may not provide benefits in preventing capsular contracture in prosthesis-based breast surgery. When the occurrence of surgical-site infections is minimized to the greatest extent, the administration of additional antibiotics for reducing capsular contracture should be carefully and judiciously considered.

Abstract P2-14-11: Antibiotic prophylaxis in prosthesis-based mammoplasty: A systematic review

Abstract Background Implants are used in over two-thirds of breast reconstructions and all aesthetic augmentations. Although considered as an aseptic surgery, infection rate after prosthesis-based breast surgery is reported to be 2% to 2.5% of patients and represents the leading cause of morbidity after reconstructive and aesthetic surgery. Therefore, prophylactic antibiotics is supported by several studies to prevent surgical site infection (SSI) and capsular contracture (CC). However, there is no high quality evidence on antibiotic prophylaxis in prosthesis-based mammoplasty. Methods An electronic search was conducted in Medline, Embase, and Cochrane. Studies of prosthesis-based breast surgery with control group and antibiotic prophylaxis were included. Two authors independently screened, assessed and then extracted information from the included studies. Mantel-Haenszel method was used to conduct meta-analysis. All analysis was performed by STATA 12.0. Studies that were not qualified to be included into meta-analysis were summarized and described. Results 15 studies were included into analysis. Average Jaded score for RCT studies was 2.5 (1-4). Average Newcastle score for non RCT studies was 7.55 (4-9). 3 studies compared systematic antibiotic prophylaxis with no antibiotic use, while no significant difference was observed. Compared with antibiotic prophylaxis within 24 hours, extended systematic antibiotic prophylaxis more than 24 hours postoperatively could significantly reduce infection rate (RR=0.638, CI 0.453-0.898). The average SSI rate was 4.6% in extended antibiotic group versus 11.1% in control group. 15.38 patients needed to be treated to prevent 1 case of SSI. However, in subgroup analysis, extended antibiotic prophylaxis could significantly decrease SSI rate in implant reconstruction surgery (RR=0.508, CI 0.349-0.739), but not in aesthetic breast surgery (RR=1.458, CI 0.602-3.528). Topical antibiotic irrigation could reduce CC rate (RR=0.472, CI 0.316-0.707), while might not be able to reduce infection rate. The average CC rate was 4.86% in topical antibiotic prophylaxis group, versus 6.81% in control group. 51.28 patients needed to be treated to prevent 1 case of Baker grade III or IV CC. Cephalosporins were the most commonly preferred antibiotic regimen in included studies. Nevertheless, there was no consensus of antibiotic prophylaxis combination or timing. Conclusions Extended systematic antibiotic prophylaxis will significantly reduce SSI rate, especially in implant breast reconstruction. Topical antibiotic irrigation would decrease CC rate, while might not be able to reduce infection rate. Cephalosporins are generally recommended as antibiotic prophylactic regimen which cover the most commonly identified implant–associated bacteria. Risk factors such as chest irradiation and diabetes should be take into consideration when prescribing antibiotic prophylaxis. More better-designed RCTs are awaited to demonstrate the proper antibiotic regimen in prosthesis-based breast surgery to reduce complications. Citation Format: Naisi Huang, Mengying Liu, Jiong Wu. Antibiotic prophylaxis in prosthesis-based mammoplasty: A systematic review [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-14-11.

Antibiotic prophylaxis in prosthesis-based mammoplasty: A systematic review

IntroductionAlthough considered as an aseptic surgery, infection after prosthesis-based mammoplasty represents the leading cause of morbidity after reconstructive and aesthetic surgery. Antibiotic prophylaxis is supported by several studies to prevent surgical site infection (SSI) and capsular contracture (CC). However, there is no high quality evidence on antibiotic prophylaxis in this area. MethodsA comprehensive literature search of Medline, Embase and CENTRAL databases was conducted for studies published through June 2014. Studies of prosthesis-based breast surgery with control group and antibiotic prophylaxis were included. Data was analyzed by meta-analysis or summarized if not qualified for meta-analysis. ResultsA total of 13 studies were included. Based on random effect model, extended systemic antibiotic prophylaxis more than 24 h postoperatively could significantly decrease infection risk (pooled RR = 0.638, 95%CI 0.453–0.898) compared with antibiotic prophylaxis within 24 h. In subgroup analysis, extended antibiotic prophylaxis could significantly decrease SSI risk in implant reconstruction surgery (pooled RR = 0.508, 95%CI 0.349–0.739), but not in aesthetic breast surgery (pooled RR = 1.458, 95%CI 0.602–3.528). Topical antibiotic irrigation could reduce CC risk (pooled RR = 0.472, 95%CI 0.316–0.707), while might not be able to reduce infection risk. Cephalosporin was the most commonly preferred antibiotic regimen in included studies, which could cover the most commonly identified implant-associated bacteria. ConclusionExtended systemic antibiotic prophylaxis should be considered to decrease SSI risk in breast implant surgery, especially in breast reconstruction. Topical antibiotic irrigation would decrease CC risk. Risk factors such as chest irradiation and diabetes should be taken into consideration when prescribing antibiotic prophylaxis.

Topical Anti-Infective Sinonasal Irrigations: Update and Literature Review

Sinonasal anti-infective irrigations have emerged as a promising therapeutic modality in the comprehensive management of chronic rhinosinusitis (CRS), particularly in the context of recalcitrant disease. The purpose of this article was to delineate the current spectrum of topical anti-infective therapies available and evaluate their role in the treatment of CRS. A systematic literature review was performed on all studies investigating the use of topical antimicrobial solutions in the medical therapy of CRS. Anti-infective irrigations were stratified into topical antibacterial, antifungal, and additive preparations according to their composition and respective microbicidal properties. The use of topical antibiotic irrigations has been supported by low-level studies in the treatment of refractory CRS, with optimal results achieved in patients who have undergone prior functional endoscopic sinus surgery and received culture-directed therapy. Multiple evidence-based reviews have not established any clinical benefit with the administration of topical antifungals, and their use is not currently recommended in the management of routine CRS. Topical additives including surfactants may be beneficial as adjunctive treatment for recalcitrant CRS, but additional research is needed to investigate their efficacy in comparison with other agents and establish safety profiles. Topical anti-infective solutions are not recommended as first-line therapy for routine CRS but may be considered as a potential option for patients with refractory CRS who have failed traditional medical and surgical intervention. Additional research is necessary to determine which patient populations would derive the most benefit from each respective irrigation regimen and identify potential toxicities associated with prolonged use.

Management of Infected Aortic Grafts

Aortic graft infection will continue to occur in a small proportion of patients who undergo reconstructive aortic surgery. For most patients, the standard approach should use extra-anatomic bypass, followed by complete excision of the graft, as the treatment of choice. However, in selected patients who have localized infection, are high risk surgical candidates, or have grafts located in positions that preclude removal, less aggressive alternatives such as topical antibiotic irrigation, graft resection with debridement and replacement, and in situ replacement with a biologic graft take an increasing role. When prosthetic grafts are developed that are less susceptible to reinfection, owing to incorporation of antibiotics into the graft, in situ replacement may become the treatment of choice. In spite of many advances in the management of aortic graft infection, this complication continues to carry a high mortality and amputation rate, and consequently should be managed by surgeons who have a particular interest and experience in managing this particular problem. With a thorough understanding of the circumstances of the original operation, bacteria infecting the graft, extent of graft infection, and management alternatives, most patients can survive prosthetic aortic graft infections with a combined morbidity and mortality of less than 50%.

Topical Antibiotic Irrigation in the Prophylaxis of Operative Wound Infections in Orthopedic Surgery

1. Although the orthopedic literature on the clinical use of topical antibiotics is sparse, the effectiveness of topical antibiotics has been shown well enough in vitro and in the surgical literature to justify strong consideration of their use in orthopedic procedures. 2. Saline irrigation should not be relied upon to reduce bacterial contamination completely, although it does remove debris, foreign material, and clot, which often contain bacteria, from the surgical wound. 3. Topical antibiotic agents used for irrigation should have a broad spectrum of antimicrobial activity. Triple antibiotic solution (neomycin, polymyxin, and bacitracin) provides the most complete coverage against the organisms most likely to cause infections in both clean and contaminated orthopedic surgical cases. These agents should be allowed to remain in the wound for at least 1 minute before their removal. 4. Further studies of topical antibiotic irrigation in orthopedic surgery are needed to demonstrate the most effective antibiotic(s) and technique of administration. 5. There is evidence to suggest that the more often an irrigant is used, the more effective it is in preventing infection. 6. The use of bacitracin as an irrigant should probably be avoided in patients previously exposed to that agent. 7. Antibiotic-containing solutions should be utilized with pulsatile lavage systems. Saline alone may drive previously administered antibiotics from bone, leaving insufficient local antibiotic levels.

Prophylactic Use of Topical Antibiotic Irrigation in Uninfected Surgical Wounds

In vitro experiments on the bacteriocidal effects of bacitracin and polymyxin B sulphate, alone and in combination, were done on a variety of microorganisms. The application of those studies to irrigation of surgical wounds with these topical antibodies in concentrations of twenty-five to fifty units per milliliter and twenty-five to fifty micrograms per milliliter respectively is suggested.