Oral antibiotics do not prevent infection or implant loss after immediate prosthetic breast reconstruction

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This retrospective study examined 1,077 women (1,687 breasts) who underwent immediate implant- or tissue expander–based postmastectomy breast reconstruction (PMBR) to determine whether extended oral antibiotic prophylaxis (EAP) after surgery reduces infections and reconstructive complications. All patients received standard perioperative intravenous antibiotics; before October 2016, some also received oral antibiotics until drain removal, after which EAP was stopped.<br /><br />The main finding was that EAP did not improve outcomes. After adjusting for factors such as age, BMI, smoking, radiation history, mastectomy weight, and reconstruction type, there were no significant differences between EAP and no-EAP groups in surgical-site infection, hospital admission, return to the operating room, or implant/expander removal. Infection rates were similar overall (7.9% with EAP vs. 9.1% without EAP).<br /><br />However, EAP was associated with a shift in the type of infecting bacteria. Infections in the EAP group were much more likely to involve Gram-negative organisms, including Pseudomonas, which may be harder to treat and may require broader-spectrum antibiotics. The study also found measurable harms from EAP: 2.0% of women developed allergic reactions, and 0.6% developed Clostridium difficile colitis.<br /><br />Independent predictors of infection included higher BMI, larger mastectomy weight, and prior radiation therapy. Predictors of explantation included higher BMI, larger mastectomy weight, and nipple-sparing mastectomy.<br /><br />Overall, the authors concluded that extended oral antibiotics after PMBR do not reduce infection or implant loss and may contribute to adverse effects and more difficult-to-treat infections. They suggest routine EAP should be reconsidered in favor of antimicrobial stewardship.

Keywords

postmastectomy breast reconstruction

extended oral antibiotic prophylaxis

surgical-site infection

implant-based reconstruction

tissue expander

Gram-negative bacteria

Pseudomonas infection

antimicrobial stewardship

Clostridium difficile

reconstructive complications