title: Surgical Site Infections in Breast Surgery: The Use of Preoperative Antibiotics for Elective, Nonreconstructive Procedures.
abstract: Background. Antibiotic prophylaxis for surgical site infections (SSIs) for breast surgery is widespread, but the benefit in clean surgical cases is not well defined.Methods. A retrospective analysis of 855 patients undergoing elective, nonreconstructive breast operations was performed, with 401 patients receiving no antibiotics and 454 patients receiving a single dose of preoperative antibiotic.Results. Administration of a preoperative antibiotic did not decrease the SSI rate. In this community-based study, antibiotic use practices varied considerably by surgeon. In univariate analyses, SSI rates appeared to increase with prophylactic antibiotic use (12% SSI with antibiotics versus 4% without,p< 0.0001), likely because the use of underdosed antibiotics was associated with higher rates of SSI (13.2% SSI with cefazolin 1 gram,p< 0.0001, and 15.4% SSI with clindamycin 300 mg or less,p= 0.0269). Methicillin-resistantStaphylococcus aureuswas the most common isolate from SSI cultures, 31.8% (7 of 22). In multivariable analyses, increased risk of SSI was associated with BMI > 25 kg/m2(OR: 1.08, 95% CI: 1.04-1.11,p< 0.0001).Conclusion. The administration of a single dose of preoperative antibiotic did not decrease the rate of SSI in this large series of patients undergoing clean breast operations. BMI >25 kg/m2and the use of an inadequate dose of antibiotics for prophylaxis may increase risk of SSI.
authors: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors: Christopher B
authors: 0000-0002-5688-8032
authors: CB
authors: Crawford
authors: Department of General Surgery, Marshfield Clinic, Marshfield, WI, USA.
authors: James A
authors: 0000-0002-6895-3807
authors: JA
authors: Clay
authors: Department of General Surgery, Marshfield Clinic, Marshfield, WI, USA.
authors: Anna S
authors: 0000-0003-2286-5198
authors: AS
authors: Seydel
authors: Department of General Surgery, Marshfield Clinic, Marshfield, WI, USA.
authors: Jessica A
authors: 0000-0002-7021-0615
authors: JA
authors: Wernberg