Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the American Association of Plastic Surgeons.
BACKGROUND
There is a growing concern for microbial resistance as a result of overuse of antibiotics. Although guidelines have focused on the use of antibiotics for surgery in general, few have addressed plastic surgery specifically. The objective of this expert consensus conference was to evaluate the evidence for efficacy and safety of antibiotic prophylaxis in plastic surgical procedures.


METHODS
THE AUTHORS: searched for existing high-quality systematic reviews for antibiotic prophylaxis in the literature from the MEDLINE, Cochrane Library, and Embase databases. All synonyms for antibiotics were combined with terms for relevant plastic surgery procedures. The searches were not limited by language, and included all study designs. In addition, supplemental hand searches were performed of bibliographies of relevant articles, and extensive "related articles." Meta-analyses were performed and reviewed by experts selected by the American Association of Plastic Surgeons to reach consensus recommendations.


RESULTS
Database searches identified 4300 articles, from which 2042 full-text articles were identified for eligibility. De novo meta-analyses were performed for each plastic surgical category. In total, 67 studies met the inclusion criteria, including nine for breast surgery, 17 for head and neck surgery, 10 for orthognathic surgery, seven for rhinoplasty/septoplasty, 19 for hand surgery, five for skin surgery, and two for abdominoplasty.


CONCLUSIONS
Systemic antibiotic prophylaxis is recommended for clean breast surgery and for contaminated surgery of the hand or the head and neck. It is not recommended to reduce infection in clean surgical cases of the hand, skin, head and neck, or abdominoplasty.
New Haven, Conn.; New Brunswick, N.J.; Ann Arbor, Mich.; Milwaukee, Wis.; Baltimore, Md.; San Francisco, Calif.; Boston, Mass.; Washington, Mo.; and London, Ontario, and Calgary, Alberta, Canada From the Department of Surgery (Plastic Surgery), Yale University; the Department of Surgery, University of Medicine and Dentistry of New Jersey; the Department of Surgery, University of Michigan; the Department of Plastic Surgery, Medical College of Wisconsin; the Department of Surgery, Johns Hopkins University; the Department of Surgery, University of California, San Francisco; the Department of Surgery, Harvard University; Mercy Health Research; the Department of Anesthesia and Perioperative Medicine, Western University; and the Department of Medicine, Microbiology, Immunology and Infectious Diseases, and Snyder Institute for Chronic Diseases, University of Calgary.
Stephan
S
Ariyan
Janet
J
Martin
Avtar
A
Lal
Davy
D
Cheng
Gregory L
GL
Borah
Kevin C
KC
Chung
John
J
Conly
Robert
R
Havlik
W P Andrew
WPA
Lee
Mary H
MH
McGrath
Julian
J
Pribaz
V Leroy
VL
Young
D019072:Antibiotic Prophylaxis / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012955:Societies, Medical; D013518:Surgery, Plastic / Q000009:adverse effects* / Q000379:methods; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States; D014945:Wound Healing / Q000502:physiology