Breast Implant-Associated Infections: The Role of the National Surgical Quality Improvement Program and the Local Microbiome.
BACKGROUND
The most common cause of surgical readmission after breast implant surgery remains infection. Six causative organisms are principally involved: Staphylococcus epidermidis and S. aureus, Escherichia, Pseudomonas, Propionibacterium, and Corynebacterium. The authors investigated the infection patterns and antibiotic sensitivities to characterize their local microbiome and determine ideal antibiotic selection.


METHODS
A retrospective review of 2285 consecutive implant-based breast procedures was performed. Included surgical procedures were immediate and delayed breast reconstruction, tissue expander exchange, and cosmetic augmentation. Patient demographics, chemotherapy and/or irradiation status, implant characteristics, explantation reason, time to infection, microbiological data, and antibiotic sensitivities were reviewed.


RESULTS
Forty-seven patients (2.1 percent) required inpatient admission for antibiotics, operative explantation, or drainage by interventional radiology. The infection rate varied depending on surgical procedure, with the highest rate seen in mastectomy and immediate tissue expander reconstruction (6.1 percent). The mean time to explantation was 41 days. Only 50 percent of infections occurred within 30 days of the indexed National Surgical Quality Improvement Program operation. The most commonly isolated organisms were coagulase-negative Staphylococcus (27 percent), methicillin-sensitive S. aureus (25 percent), methicillin-resistant S. aureus (7 percent), Pseudomonas (7 percent), and Peptostreptococcus (7 percent). All Gram-positive organisms were sensitive to vancomycin, linezolid, tetracycline, and doxycycline; all Gram-negative organisms were sensitive to gentamicin and cefepime.


CONCLUSIONS
Empiric antibiotics should be vancomycin (with the possible inclusion of gentamicin) based on their broad effectiveness against the authors' unique microbiome. Minor infections should be treated with tetracycline or doxycycline as a second-line agent. National Surgical Quality Improvement Program data are adequate for monitoring and comparing breast infections but certainly not comprehensive.


METHODS
Therapeutic, IV.
St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine; and Infection Prevention, Barnes-Jewish West County Hospital.
Justin B
JB
Cohen
Cathy
C
Carroll
Marissa M
MM
Tenenbaum
Terence M
TM
Myckatyn
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018427:Breast Implants / Q000009:adverse effects*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D064307:Microbiota; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D058996:Quality Improvement / Q000458:organization & administration*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012380:Role; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents