title: A systematic review of infection rates and associated antibiotic duration in acellular dermal matrix breast reconstruction.
abstract: BACKGROUND
  Reported infection rates in breast reconstruction with acellular dermal matrix (ADM) can exceed 31%. Prophylactic antibiotics remain controversial due to the absence of evidence-based literature. The purpose of this study was to examine published antibiotic regimens and their associated infection rates in this population.
  
  
  METHODS
  Systematic electronic searches were performed in PubMed, OVID, and the Cochrane databases for studies that reported on prophylactic antibiotic use and infection in patients undergoing ADM breast reconstruction. Two independent authors reviewed studies between 1970 and 2012 for inclusion and data extraction.
  
  
  RESULTS
  A total of 863 studies were identified and abstracts reviewed. A total of 24 articles were included, with 2148 patients and 3189 ADM reconstructions. Mean infection rates varied between 0% and 31.25%, with a combined average of 11.59%. When comparing antibiotic protocols of less than 24 hours and more than 24 hours, the average infection rate was 2.48% and 13.21%, respectively.
  
  
  CONCLUSIONS
  The current literature lacks consensus on the necessary duration for postoperative antibiotic prophylaxis following breast reconstruction. The potential increased risk of infection associated with ADM remains controversial. Because of the lack of supportive evidence, we do not recommend prolonged postoperative antibiotics in ADM breast reconstruction.
  
  
  METHODS
  Therapeutic level III evidence.
authors.affiliation: Division of Plastic, Maxillofacial, & Oral Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Phillips
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Muath
authors.initials: M
authors.lastname: Bishawi
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stony Brook University Hospital, Stony Brook University School of Medicine, Stony Brook, NY.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Dagum
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stony Brook University Hospital, Stony Brook University School of Medicine, Stony Brook, NY.
authors.forename: Duc T
authors.initials: DT
authors.lastname: Bui
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stony Brook University Hospital, Stony Brook University School of Medicine, Stony Brook, NY.
authors.forename: Sami U
authors.initials: SU
authors.lastname: Khan
keywords: ADM; acellular dermal matrix; antibiotics; breast reconstruction; infection