title: Breast implant infections: is cefazolin enough?
abstract: BACKGROUND
  Bacterial infection is a well-known risk of breast implant surgery, occurring in 2.0 to 2.5 percent of cosmetic cases and up to 20 percent of reconstructive cases. The Centers for Disease Control and Prevention recommends a first-generation cephalosporin for perioperative prophylaxis; however, no guidelines exist for the empiric treatment of established breast implant infections. A recent increase in methicillin-resistant Staphylococcus aureus infections has prompted interest in using alternative antibiotics with anti-methicillin-resistant S. aureus activity for both prophylactic and empiric therapy. The goal of the present study was to assess the bacteriology and antibiotic susceptibility of breast implant-related infections at two tertiary care hospitals in the Texas Medical Center to determine whether a baseline for empiric therapy for breast implant infections could be established.
  
  
  METHODS
  A retrospective review of patients who developed periprosthetic infections within 1 month after breast implant placement between 2001 and 2006 was completed. One hundred six patients with 116 infected breasts were identified. Patients were included in the study only if they had documented culture data.
  
  
  RESULTS
  Thirty-one breasts in 26 patients met inclusion criteria. Sixty-seven percent of the infected breasts had S. aureus infections; of these, 68 percent were methicillin-resistant S. aureus infections and 32 percent were methicillin-susceptible S. aureus infections. We noted Gram-negative rods and sterile cultures in 6 percent and 26 percent of breasts, respectively.
  
  
  CONCLUSIONS
  Because of the high incidence of methicillin-resistant S. aureus infections in breast implant recipients, we believe that choosing an antibiotic with anti-methicillin-resistant S. aureus activity is justified for empiric treatment of breast implant infections, until culture and sensitivity data, if obtained, become available.
authors.affiliation: Houston, Texas From the Division of Plastic Surgery, Baylor College of Medicine, and the Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Feldman
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Safa E
authors.initials: SE
authors.lastname: Sharabi
authors.forename: Edward
authors.initials: E
authors.lastname: Lee
authors.forename: Yoav
authors.initials: Y
authors.lastname: Kaufman
authors.forename: Lior
authors.initials: L
authors.lastname: Heller
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018427:Breast Implants / Q000009:adverse effects*; D002437:Cefazolin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin
references.citation: Kjøller K, Hölmich LR, Jacobsen PH, et al. Epidemiological investigation of local complications after cosmetic breast implant surgery in Denmark. Ann Plast Surg. 2002;48:229–237.
references.citation: Gabriel SE, Woods JE, O'Fallon WM, Beard CM, Kurland LT, Melton LJ III. Complications leading to surgery after breast implantation. N Engl J Med. 1997;226:677–682.
references.citation: Pittet B, Montandon D, Pittet D. Infection in breast implants. Lancet Infect Dis. 2005;5:94–106.
references.citation: De Cholnoky T. Augmentation mammaplasty: Survey of complications in 10,941 patients by 265 surgeons. Plast Reconstr Surg. 1970;45:573–577.
references.citation: Daum RS. Clinical practice: Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007;357:380–390.
references.citation: Moran GJ, Krishnadasan A, Gorwitz RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666–674.
references.citation: Miller TA. Modern Surgical Care. 3rd ed. St. Louis: Quality Medical; 2006:149.
references.citation: Francis SH, Ruberg RL, Stevenson KB, et al. Independent risk factors for infection in tissue expander breast reconstruction. Plast Reconstr Surg. 2009;124:1790–1796.
references.citation: Costerton JW, Montanaro L, Arciola CR. Biofilm in implant infections: Its production and regulation. Int J Artif Organs 2005;28:1062–1068.
references.citation: Curtin J, Cormican M, Fleming G, Keelehan J, Colleran E. Linezolid compared with eperezolid, vancomycin, and gentamicin in an in vitro model of antimicrobial lock therapy for Staphylococcus epidermidis central venous catheter-related biofilm infections. Antimicrob Agents Chemother. 2003;47:3145–3148.
references.citation: Evans RC, Holmes CJ. Effect of vancomycin hydrochloride on Staphylococcus epidermidis biofilm associated with silicone elastomer. Antimicrob Agents Chemother. 1987;31:889–894.
references.citation: Farber BF, Kaplan MH, Clogston AG. Staphylococcus epidermidis biofilm associated with silicone elastomer. Antimicrob Agents Chemother. 1990;161:37–40.
references.citation: Raad I, Darouiche R, Hachem R, Sacilowski M, Bodey GP. Antibiotics and prevention of microbial colonization of catheters. Antimicrob Agents Chemother. 1995;39:2397–2400.
references.citation: Wiederhold NP, Coyle EA, Raad II, Prince RA, Lewis RE. Antibacterial activity of linezolid and vancomycin in an in vitro pharmacodynamic model of gram-positive catheter-related bacteraemia. J Antimicrob Agents Chemother. 2005;55:792–795.
references.citation: Raad I, Hanna H, Jiang Y, et al. Comparative activities of daptomycin, linezolid, and tigecycline against catheter-related methicillin-resistant Staphylococcus bacteremic isolates embedded in biofilm. Antimicrob Agents Chemother. 2007;51:1656–1660.
references.citation: Garey KW, Dao T, Chen H, et al. Timing of vancomycin prophylaxis for cardiac surgery patients and the risk of surgical site infections. J Antimicrob Chemother. 2006;58:645–650.
references.citation: Luzzati R, Sanna A, Allegranzi B, et al. Pharmacokinetics and tissue penetration of vancomycin in patients undergoing prosthetic mammary surgery. J Antimicrob Chemother. 2000;45:243–245.
references.citation: Steinkraus G, White R, Friedrich L. Vancomycin MIC creep in non-vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-susceptible clinical methicillin-resistant S. aureus (MRSA) blood isolates from 2001–05. J Antimicrob Chemother. 2007;60:788–794.