title: Extended trimethoprim/sulfamethoxazole prophylaxis for implant reconstruction in the previously irradiated chest wall.
abstract: BACKGROUND
  Patients who have undergone prior chest wall irradiation can present as challenging candidates for implant reconstruction because of troublesome rates of infectious complications. The issue of antibiotic prophylaxis remains controversial, and evidence-based postoperative strategies to reduce implant infections have not been well described in the literature. The purpose of this study was to determine the efficacy of extended trimethoprim/sulfamethoxazole therapy in preventing implant infections in the irradiated chest wall.
  
  
  METHODS
  A retrospective chart review of hospital and office records was performed on all patients undergoing implant reconstruction performed by a single surgeon (J.M.S.) from August of 2005 to March of 2008. Before 2007, the senior author used 5 to 7 days of cephalosporin prophylaxis. Subsequent to this period, the prophylactic regimen was amended to provide patients with previous chest wall irradiation prophylactic trimethoprim/sulfamethoxazole for 30 days after implant insertion.
  
  
  RESULTS
  Fifty-one implant reconstructions, in the setting of prior ipsilateral chest wall irradiation, were performed. The mean follow-up time was 39 months. The infection rate for the routine cephalosporin group was 35 percent as compared with 8 percent for the extended trimethoprim/sulfamethoxazole group (p = 0.038). After multivariate analysis, extended trimethoprim/sulfamethoxazole remained the only significant factor that influenced the rate of infection (p = 0.05). The mean time to infection was 13 weeks for the routine cephalosporin group and 1.5 weeks for the extended trimethoprim/sulfamethoxazole group (p = 0.044).
  
  
  CONCLUSIONS
  Extended trimethoprim/sulfamethoxazole therapy demonstrates preliminary evidence as an effective adjunctive measure for reducing the rate of implant infections in breast reconstruction.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, University of Pennsylvania Health System.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mirzabeigi
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.forename: James M
authors.initials: JM
authors.lastname: Smartt
authors.forename: Shareef
authors.initials: S
authors.lastname: Jandali
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
mesh_terms: D000328:Adult; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002511:Cephalosporins / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012189:Retrospective Studies; D035441:Thoracic Wall / Q000528:radiation effects; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D002511:Cephalosporins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination