title: An updated meta-analysis on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures.
abstract: To systematically analyze published randomized trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures. Trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgery were selected and analyzed to generate summated data (expressed as risk ratio [RR]) by using RevMan 5.0. Nine randomized controlled trials encompassing 3720 patients undergoing breast surgery were retrieved from the electronic databases. The antibiotics group comprised a total of 1857 patients and non-antibiotics group, 1863 patients. There was no heterogeneity [χ(2) = 7.61, d.f. = 7, p < 0.37; I(2) = 8%] amongst trials. Therefore, in the fixed-effects model (RR, 0.64; 95% CI, 0.50-0.83; z = 3.48; p < 0.0005), the use of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures was statistically significant in reducing the incidence of surgical site infection (SSI). Furthermore, in the fixed-effects model (RR, 1.30; 95% CI, 0.89-1.90; z = 1.37; p < 0.17), adverse reactions secondary to the use of prophylactic antibiotics was not statistically significant between the two groups. Preoperative prophylactic antibiotics significantly reduce the risk of SSI after breast surgical procedures. The risk of adverse reactions from prophylactic antibiotic administration is not significant in these patients. Therefore, preoperative prophylactic antibiotics in breast surgery patients may be routinely administered. Further research is required, however, on risk stratification for SSI, timing and duration of prophylaxis, and the need for prophylaxis in patients undergoing breast reconstruction versus no reconstruction.
authors.affiliation: Department of Breast and Oncoplastic Surgery, Worthing Hospital, Worthing, West Sussex, United Kingdom. surgeon1wrh@hotmail.com
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Sajid
authors.forename: Kristian
authors.initials: K
authors.lastname: Hutson
authors.forename: Naved
authors.initials: N
authors.lastname: Akhter
authors.forename: Lorain
authors.initials: L
authors.lastname: Kalra
authors.forename: Ignacio F
authors.initials: IF
authors.lastname: Rapisarda
authors.forename: Ricardo
authors.initials: R
authors.lastname: Bonomi
mesh_terms: D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D001940:Breast / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*