Prevention of surgical site infection after breast cancer surgery by targeted prophylaxis antibiotic in patients at high risk of surgical site infection.
OBJECTIVE
We previously showed that previous chemotherapy and immediate breast reconstruction were associated with an increased risk of surgical site infection (SSI) in patients undergoing breast cancer surgery. The present before-after study evaluated a preventive strategy for high-risk patients.


METHODS
We compared the incidence of SSI in two prospective observational cohorts of patients underwent clean procedure in curative intent for a-biopsy proven breast cancer: a historical cohort followed before implementation of a preventive strategy and a second cohort followed thereafter. The strategy consisted of identifying patients at risk of SSI and prophylaxis administration of cefuroxime to those patients. The impact of our strategy was analyzed using a logistic regression model adjusted for potential confounders.


RESULTS
SSI incidence was estimated at 19/542 (3.5%) before preventive strategy versus 2/247 (0.8%) thereafter (crude odds ratio (OR) 0.22 confidence interval [95% CI 0.05-0.97], P = 0.03). After adjustment for confounders (breast reconstruction, previous breast surgery, and duration of surgery), our preventive strategy reduced the risk of SSI by 81% (adjusted OR 0.19 [95% CI 0.04-0.85], P = 0.03).


CONCLUSIONS
These results showed that antibiotic prophylaxis is beneficial for patients at high-risk of WI after breast cancer surgery. Randomized controlled trials should now confirm these findings.
Penel
Nicolas
N
Département de Cancérologie Générale, Centre Oscar Lambret, France. n-penel@o-lambret.fr
Nicolas
Penel
P
Yazdanpanah
Yazdan
Y
Yazdan
Yazdanpanah
Y
Chauvet
Marie-Pierre
MP
Marie-Pierre
Chauvet
C
Clisant
Stéphanie
S
Stéphanie
Clisant
C
Giard
Sylvia
S
Sylvia
Giard
G
Neu
Jean-Charles
JC
Jean-Charles
Neu
N
Lefebvre
Danièle
D
Danièle
Lefebvre
L
Fournier
Charles
C
Charles
Fournier
F
Bonneterre
Jacques
J
Jacques
Bonneterre
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D018567:Breast Neoplasms, Male / Q000601:surgery; D002444:Cefuroxime / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011787:Quality of Health Care; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D002444:Cefuroxime