title: A systematic review of antibiotic use and infection in breast reconstruction:  what is the evidence?
abstract: BACKGROUND
  The literature reports overall complication rates in breast reconstruction to be as high as 60 percent. Infection rates can exceed 20 percent, much higher than anticipated in clean elective surgery. There is no consensus among surgeons regarding the necessary duration of antibiotic prophylaxis, although the Centers for Disease Control and Prevention guidelines suggest only 24 hours. This systematic review examines antibiotic regimens and associated infection rates in breast reconstruction.
  
  
  METHODS
  Systematic electronic searches were performed in the PubMed, Ovid, and Cochrane databases using Medical Subject Headings terms for studies reporting antibiotic use and infection in all forms of breast reconstruction. Studies between 1970 and 2011 were reviewed. Included publications were required to report an antibiotic protocol and infection rate.
  
  
  RESULTS
  A total of 834 abstracts were identified, 81 of which met inclusion criteria and were included in the review. The overall reported infection rates in the included studies varied between 0 and 29 percent (average, 5.8 percent). When comparing combined patient cohorts receiving no antibiotics, less than 24 hours, and greater than 24 hours, the average infection rates were 14.4, 5.8, and 5.8 percent, respectively.
  
  
  CONCLUSIONS
  There is no consensus on the necessary duration of antibiotic prophylaxis following breast reconstruction. No benefit was found in patients who received more than 24 hours of postoperative antibiotics. Standardized definitions for antibiotic regimens, unit of analysis reporting, and a new breast reconstruction surgical-site infection grading system are offered to improve standardized outcome documentation. Randomized controlled trials are warranted to best determine an optimal antibiotic regimen.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Stony Brook, N.Y. From the Division of Plastic and Reconstructive Surgery, Stony Brook University Medical Center, and the Stony Brook University School of Medicine.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Phillips
authors.forename: Muath
authors.initials: M
authors.lastname: Bishawi
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Dagum
authors.forename: Sami U
authors.initials: SU
authors.lastname: Khan
authors.forename: Duc T
authors.initials: DT
authors.lastname: Bui
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods*; D018427:Breast Implants / Q000009:adverse effects*; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States