title: Clinical and Microbiological Characterization of Late Breast Implant Infections after Reconstructive Breast Cancer Surgery.
abstract: BACKGROUND
  Implant infections represent a relevant problem after immediate breast cancer reconstruction. In addition to difficulties in distinguishing early infections from other post-surgical complications (such as hematoma, seroma, and liponecrosis) late breast implant infections still represent a grey area of our knowledge with regards to heir definition and management. To address this issue, we prospectively monitored breast cancer patients at their center.
  
  
  METHODS
  Between February 1, 2009, and May 31, 2013, we enrolled all patients undergoing breast implant reconstruction or expander-to-prosthesis substitution. Patients without at least 6 mo of post-operative observation were excluded. We collected data from patient records including age, days from surgery (DFS), chemotherapy/radiotherapy, infecting microorganism, type of implant, antibiotic management and eventual implant removal. Sixty days from surgery were defined as the clinical threshold between early and late infection. Infections were further classified according to a graded scale into possible, probable and microbiologically proved.
  
  
  RESULTS
  Seventy-eight infections were recorded out of 766 surgical procedures (10.2%). Fifty-three (67%) cases occurred early ≤60 DFS, and 25 (33%) occurred late (i.e., beyond 60 d). By defining infection types as possible, probable or proved, the majority of late infections were classified as proved (84%) compared with 56% of early infections (p=0.0014). Microbiological isolate distribution was similar in proved early infections compared with proved late infections. Among late infections, a delayed occurrence was observed after prosthesis placement compared with expander insertion. Late infections were fraught with lower treatment success rates (12% vs. 41%, p=0.009).
  
  
  CONCLUSIONS
  Late infection represents a consistent proportion of infections after immediate breast implant reconstruction or prosthesis placement and bear lower chance of salvage after treatment. An increased attention is warranted to improve prevention and treatment strategies.
authors.affiliation: 1 SC Chirurgia Plastica e Ricostruttiva, IRCCS AOU San Martino-IST , Genoa, Italy .
authors.forename: Simonetta
authors.initials: S
authors.lastname: Franchelli
authors.affiliation: 1 SC Chirurgia Plastica e Ricostruttiva, IRCCS AOU San Martino-IST , Genoa, Italy .
authors.forename: Marianna
authors.initials: M
authors.lastname: Pesce
authors.affiliation: 1 SC Chirurgia Plastica e Ricostruttiva, IRCCS AOU San Martino-IST , Genoa, Italy .
authors.forename: Serena
authors.initials: S
authors.lastname: Savaia
authors.affiliation: 2 Sezione di Microbiologia DISC, University of Genoa , Genoa, Italy .
authors.forename: Anna
authors.initials: A
authors.lastname: Marchese
authors.affiliation: 2 Sezione di Microbiologia DISC, University of Genoa , Genoa, Italy .
authors.forename: Ramona
authors.initials: R
authors.lastname: Barbieri
authors.affiliation: 3 Department of Health Sciences DISC, University of Genoa , Genoa, Italy .
authors.forename: Ilaria
authors.initials: I
authors.lastname: Baldelli
authors.affiliation: 3 Department of Health Sciences DISC, University of Genoa , Genoa, Italy .|4 UOS Infettivologia dell'Ospite Immunocompromesso IRCCS AOU San Martino-IST , Genoa, Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: De Maria
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents