Bacteriologic features of surgical site infections following breast surgery.
BACKGROUND
Perioperative antibiotic prophylaxis to prevent surgical site infections (SSIs) after breast surgery is common practice. Breast SSIs were investigated to determine bacterial isolates, resistance patterns, and the appropriateness of cefazolin, the authors' institution's current regimen for perioperative antibiotic prophylaxis.


METHODS
A retrospective review of 53 patients with culture-positive breast SSIs between June 1997 and August 2008 identified patient characteristics, bacterial isolates, and microbial resistance patterns.


RESULTS
Among the 53 patients with positive cultures, 42% (n = 22) had undergone mastectomy, and 34% (n = 18) had undergone lumpectomy. Sixty-three bacterial isolates were identified, with 15% of SSIs being polymicrobial. Of the isolates, 49% (n = 31) were gram-negative bacteria. There was only 1 case of methicillin-resistant Staphylococcus aureus. Eight of 63 (13%) gram-negative isolates were cefazolin resistant.


CONCLUSIONS
Gram-negative SSIs constituted half of the SSIs in this breast surgery cohort. Of all breast isolates, 17.5% were resistant to cefazolin. On the basis of these findings, antibiotic prophylaxis regimens alternative to cefazolin should be considered.
Department of Surgery, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA.
Rita A
RA
Mukhtar
Alyssa D
AD
Throckmorton
Michael D
MD
Alvarado
Cheryl A
CA
Ewing
Laura J
LJ
Esserman
Charles
C
Chiu
E Shelley
ES
Hwang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification / Q000378:metabolism; D006094:Gram-Positive Bacteria / Q000302:isolation & purification / Q000378:metabolism; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D002437:Cefazolin