title: Breast tissue expander-related infections: perioperative antimicrobial regimens.
abstract: OBJECTIVE
  The rate of postmastectomy tissue expander (TE) infection remains excessively high, ranging between 2% and 24%. We hypothesized that current perioperative antimicrobial regimens utilized for breast TE reconstruction may be outdated as a result of recent changes in microflora and susceptibility patterns.
  
  
  METHODS
  We reviewed the records of all patients who had a TE reconstructive procedure and developed a definite breast TE infection between 2003 and 2010 at MD Anderson Cancer Center. Antimicrobials were stratified into 3 groups: systemic perioperative, local irrigation, and oral immediate postoperative antimicrobials. These were considered discordant if they did not target the isolated organisms, while a breakthrough infection was defined as an infection that occurred despite concordant antimicrobial coverage.
  
  
  RESULTS
  Overall, 75 patients with a definite TE infection were identified. The most common organisms identified were methicillin-resistant Staphylococcus epidermidis (29%), methicillin-resistant Staphylococcus aureus (15%), and gram-negative rods (26%). The use of systemic perioperative antimicrobials was deemed discordant in 51% of the cases. Although 79% of the patients received broad-spectrum perioperative local antimicrobial irrigation, 63% developed a breakthrough infection. Even though 61% received oral postoperative prophylactic antimicrobials, 63% of the times they were deemed discordant.
  
  
  CONCLUSIONS
  Contrary to the proven effectiveness of a single dose of perioperative antibiotics, the common use of local antimicrobial irrigation and prolonged postoperative oral antibiotics appears to be an inadequate component of our preventive armamentarium. Also, because methicillin-resistant staphylococcal and pseudomonal infections occurred approximately 60% of the time, at institutions that have observed an increase of these organisms, it may be prudent that perioperative antimicrobials target these microorganisms.
authors: Division of Medicine, Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: George M
authors: GM
authors: Viola
authors: Issam I
authors: II
authors: Raad
authors: Kenneth V
authors: KV
authors: Rolston
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D019990:Perioperative Care; D011552:Pseudomonas Infections / Q000382:microbiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013212:Staphylococcus epidermidis; D007507:Therapeutic Irrigation; D013997:Time Factors; D015625:Tissue Expansion Devices / Q000009:adverse effects* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents