title: Breast implant infections after surgical reconstruction in patients with breast cancer: assessment of risk factors and pathogens over extended post-operative observation.
abstract: BACKGROUND
  Infection is a severe potential complication of breast implant positioning in women with cancer. There still is some degree of uncertainty regarding optimal antibiotic prophylaxis regimens, infecting pathogens, and risk factors associated with infection during long-term followup of these patients.
  
  
  METHODS
  We performed a systematic clinical review to assess infecting microorganisms and risk factors among patients undergoing reconstructive procedures for breast cancer between January 2005 and February 2007. A randomly selected group of infection-free patients treated over the same time span was considered as a control.
  
  
  RESULTS
  Among 240 women undergoing implant procedures performed and followed up as outpatients, 16 patients with prosthetic infections were observed (infection rate 6.7%). Infection was recorded within six months from surgery in 94% of the cases, with an overall mean time to infection of 95 days. The time interval between surgery and infection did not support a diagnosis of hospital-acquired infection in most cases. Gram-negative microorganisms were identified in seven cases. A higher proportion of patients with implant infection underwent radiotherapy or chemotherapy after surgery for advanced tumors compared with the control patients without infection.
  
  
  CONCLUSIONS
  Extended post-operative surveillance is indicated, at least for the first six months after breast implant placement, particularly for women who need radiotherapy or chemotherapy after implant surgery. Gram-negative bacilli may be involved more often in late infections than otherwise expected. This finding may influence initial empiric antibiotic treatment.
authors.affiliation: SC Chirurgia Plastica e Ricostruttiva, IRCCS Azienda Ospedaliera Universitaria San Martino-IST-Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy. simonettafranchelli@yahoo.it
authors.forename: Simonetta
authors.initials: S
authors.lastname: Franchelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Vassallo
authors.forename: Claudia
authors.initials: C
authors.lastname: Porzio
authors.forename: Matilde
authors.initials: M
authors.lastname: Mannucci
authors.forename: Virginia
authors.initials: V
authors.lastname: Priano
authors.forename: Eva
authors.initials: E
authors.lastname: Schenone
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Leone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Canavese
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Santi
authors.forename: Andrea
authors.initials: A
authors.lastname: De Maria
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods; D001419:Bacteria / Q000302:isolation & purification; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008875:Middle Aged; D011182:Postoperative Care; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology; D013997:Time Factors