Plastic and Reconstructive Surgery Journal had a study where they looked at studies to ask the question:
Do longer courses of antibiotics reduce the incidence of infection after surgery in breast reconstruction with implants?
This is a big question. There are varying recommendations on how long do you use antibiotics after any surgery. The current recommendation for many surgeries is a single dose of antibiotic IV prior to surgery, maybe with 24 hours of antibiotics after. But with breast cancer reconstruction with an implant you are putting in a foreign object- the implant. Read all of my blogs on biofilm, and you will understand why you need to be more vigilant when putting in a foreign object. So with the pressure to try to limit antibiotics to avoid superbug bacteria resistant to antibiotics, and with the pressure to avoid biofilm and capsular contracture, what should we do? “Do Prolonged Prophylactic Antibiotics Reduce the Incidence of Surgical Site Infections in Immediate Prosthetic Breast Reconstruction?”
Background: 50,000 women have mastectomy and immediate reconstruction with implants every year. What is the effect of antibiotics on post surgical infections?
Study:
- Identified studies which looked at antibiotics 24 hours or less OR over 24 hours (multi day)
- Found 927 studies, but only 4 cohort studies and one randomized controlled trial met their criteria.
- Infection rate
- 19% with less than 24 hours of antibiotics
- 14% with more than 24 hours
- Implant loss
- 10% with less than 24 hours of antibiotics
- 8% with more than 24 hours.
They conclude there was no statistical significance between under/over 24 hours of antibiotics, but realize there was a lot of issues when trying to compare the studies, and need a prospective randomized trial.
Why do we care and what are my thoughts?
This is a good idea for a study, but hasn’t helped figure this out better. I agree we need a new prospective randomized trial. We want to avoid the superbug bacteria. Antibiotic resistance is looming, and I absolutely agree with trying to avoid future issues by overusing antibiotics. The issue with a foreign object like a breast implant though is a trickier one. They used as their endpoints post surgical infection or loss of implant. Follow up times in the studies varied from months to a year and a half. But what about capsular contracture? Biofilm is a well described phenomenon, and a longer course of antibiotics until the body has formed around a capsule to “protect’ the breast implant is a viable theory. It was not addressed at all in this study.
Studies like these are hard. Are the patients pre or post menopausal? Other comorbidities? bilateral or one side? Radiation? Given the numbers, a randomized prospective trial is what is needed. I would include other parameters to evaluate though, like capsular contracture.