Hostname: page-component-77c78cf97d-kmjgn Total loading time: 0.001 Render date: 2026-04-23T07:17:03.615Z Has data issue: false hasContentIssue false
  • English
  • Français

Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction

Published online by Cambridge University Press:  27 September 2021

David K. Warren Open the ORCID record for David K. Warren [Opens in a new window] ,
Kate M. Peacock ,
Katelin B. Nickel Open the ORCID record for Katelin B. Nickel [Opens in a new window] ,
Victoria J. Fraser Open the ORCID record for Victoria J. Fraser [Opens in a new window] ,
Margaret A. Olsen Open the ORCID record for Margaret A. Olsen [Opens in a new window]  and
for the CDC Prevention Epicenter Program
David K. Warren
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Kate M. Peacock
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Katelin B. Nickel
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri
*
Author for correspondence: Margaret A. Olsen, E-mail: molsen@wustl.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Prophylactic antibiotics are commonly prescribed at discharge for mastectomy, despite guidelines recommending against this practice. We investigated factors associated with postdischarge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI).

Study design:

We studied a cohort of women aged 18–64 years undergoing mastectomy between January 1, 2010, and June 30, 2015, using the MarketScan commercial database. Patients with nonsurgical perioperative infections were excluded. Postdischarge oral antibiotics were identified from outpatient drug claims. SSI was defined using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnosis codes. Generalized linear models were used to determine factors associated with postdischarge prophylactic antibiotic use and SSI.

Results:

The cohort included 38,793 procedures; 24,818 (64%) with immediate reconstruction. Prophylactic antibiotics were prescribed after discharge after 2,688 mastectomy-only procedures (19.2%) and 17,807 mastectomies with immediate reconstruction (71.8%). The 90-day incidence of SSI was 3.5% after mastectomy only and 8.8% after mastectomy with immediate reconstruction. Antibiotics with anti–methicillin-sensitive Staphylococcus aureus (MSSA) activity were associated with decreased SSI risk after mastectomy only (adjusted relative risk [aRR], 0.74; 95% confidence interval [CI], 0.55–0.99) and mastectomy with immediate reconstruction (aRR, 0.80; 95% CI, 0.73–0.88), respectively. The numbers needed to treat to prevent 1 additional SSI were 107 and 48, respectively.

Conclusions:

Postdischarge prophylactic antibiotics were common after mastectomy. Anti-MSSA antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. The high numbers needed to treat suggest that potential benefits of postdischarge antibiotics should be weighed against potential harms associated with antibiotic overuse.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 10 , October 2022 , pp. 1382 - 1388
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

PREVIOUS PRESENTATION. Preliminary results for this study were presented at IDWeek 2018 on October 6, 2018, in San Francisco, California.

References

Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of healthcare-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Berrios-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784–791.CrossRefGoogle ScholarPubMed
Alderman, A, Gutowski, K, Ahuja, A, Gray, D. ASPS clinical practice guideline summary on breast reconstruction with expanders and implants. Plast Reconstr Surg 2014;134:648e–655e.CrossRefGoogle ScholarPubMed
Phillips, BT, Wang, ED, Mirrer, J, et al. Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care. Ann Plast Surg 2011;66:460–465.CrossRefGoogle ScholarPubMed
Brahmbhatt, RD, Huebner, M, Scow, JS, et al. National practice patterns in preoperative and postoperative antibiotic prophylaxis in breast procedures requiring drains: survey of the american society of breast surgeons. Ann Surg Oncol 2012;19:3205–3211.CrossRefGoogle ScholarPubMed
Clayton, JL, Bazakas, A, Lee, CN, Hultman, CS, Halvorson, EG. Once is not enough: withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of infection. Plast Reconstr Surg 2012;130:495–502.CrossRefGoogle Scholar
Avashia, YJ, Mohan, R, Berhane, C, Oeltjen, JC. Postoperative antibiotic prophylaxis for implant-based breast reconstruction with acellular dermal matrix. Plast Reconstr Surg 2013;131:453–461.CrossRefGoogle ScholarPubMed
Mirzabeigi, MN, Lee, M, Smartt, JM Jr, Jandali, S, Sonnad, SS, Serletti, JM. Extended trimethoprim/sulfamethoxazole prophylaxis for implant reconstruction in the previously irradiated chest wall. Plast Reconstr Surg 2012;129:37e–45e.CrossRefGoogle ScholarPubMed
Holland, M, Lentz, R, Sbitany, H. Utility of postoperative prophylactic antibiotics in prepectoral breast reconstruction: a single-surgeon experience. Ann Plast Surg 2021;86:24–28.CrossRefGoogle ScholarPubMed
Edwards, BL, Stukenborg, GJ, Brenin, DR, Schroen, AT. Use of prophylactic postoperative antibiotics during surgical drain presence following mastectomy. Ann Surg Oncol 2014;21:3249–3255.CrossRefGoogle ScholarPubMed
Olsen, MA, Nickel, KB, Fox, IK. Surveillance and prevention of surgical site infections in breast oncologic surgery with immediate reconstruction. Curr Treat Options Infect Dis 2017;9:155–172.CrossRefGoogle ScholarPubMed
Liu, DZ, Dubbins, JA, Louie, O, Said, HK, Neligan, PC, Mathes, DW. Duration of antibiotics after microsurgical breast reconstruction does not change surgical infection rate. Plast Reconstr Surg 2012;129:362–367.CrossRefGoogle Scholar
McCullough, MC, Chu, CK, Duggal, CS, Losken, A, Carlson, GW. Antibiotic prophylaxis and resistance in surgical site infection after immediate tissue expander reconstruction of the breast. Ann Plast Surg 2016;77:501–505.CrossRefGoogle ScholarPubMed
Townley, WA, Baluch, N, Bagher, S, et al. A single preoperative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: a matched cohort study. J Plast Reconstr Aesthet Surg 2015;68:673–678.CrossRefGoogle Scholar
Throckmorton, AD, Boughey, JC, Boostrom, SY, et al. Postoperative prophylactic antibiotics and surgical site infection rates in breast surgery patients. Ann Surg Oncol 2009;16:2464–2469.CrossRefGoogle ScholarPubMed
Drury, KE, Lanier, ST, Khavanin, N, et al. Impact of postoperative antibiotic prophylaxis duration on surgical site infections in autologous breast reconstruction. Ann Plast Surg 2016;76:174–179.CrossRefGoogle ScholarPubMed
Warren, DK, Nickel, KB, Hostler, CJ, et al. Surgeon choice in the use of postdischarge antibiotics for prophylaxis following mastectomy with and without breast reconstruction. Infect Control Hosp Epidemiol 2021;42:467–470.CrossRefGoogle ScholarPubMed
Olsen, MA, Nickel, KB, Fraser, VJ, Wallace, AE, Warren, DK. Prevalence and predictors of postdischarge antibiotic use following mastectomy. Infect Control Hosp Epidemiol 2017;38:1048–1054.CrossRefGoogle ScholarPubMed
Ranganathan, K, Sears, ED, Zhong, L, et al. Antibiotic prophylaxis after immediate breast reconstruction: the reality of its efficacy. Plast Reconstr Surg 2018;141:865–877.CrossRefGoogle ScholarPubMed
Phillips, BT, Fourman, MS, Bishawi, M, et al. Are prophylactic postoperative antibiotics necessary for immediate breast reconstruction? Results of a prospective randomized clinical trial. J Am Coll Surg 2016;222:1116–1124.CrossRefGoogle ScholarPubMed
Yamin, F, Nouri, A, McAuliffe, P, et al. Routine postoperative antibiotics after tissue expander placement postmastectomy does not improve outcome. Ann Plast Surg 2021;87 suppl 1:S28–S30.Google Scholar
Harbarth, S, Samore, MH, Lichtenberg, D, Carmeli, Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 2000;101:2916–2921.CrossRefGoogle ScholarPubMed
Poeran, J, Mazumdar, M, Rasul, R, et al. Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2016;151:589–597.CrossRefGoogle ScholarPubMed
Branch-Elliman, W, O’Brien, W, Strymish, J, Itani, K, Wyatt, C, Gupta, K. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events. JAMA Surg 2019;154:590–598.CrossRefGoogle ScholarPubMed
Bernatz, JT, Safdar, N, Hetzel, S, Anderson, PA. Antibiotic overuse is a major risk factor for Clostridium difficile infection in surgical patients. Infect Control Hosp Epidemiol 2017;38:1254–1257.CrossRefGoogle ScholarPubMed
Balch, A, Wendelboe, AM, Vesely, SK, Bratzler, DW. Antibiotic prophylaxis for surgical site infections as a risk factor for infection with Clostridium difficile. PLoS One 2017;12:e0179117.CrossRefGoogle ScholarPubMed
MacFadden, DR, Fisman, DN, Hanage, WP, Lipsitch, M. The relative impact of community and hospital antibiotic use on the selection of extended-spectrum beta-lactamase–producing Escherichia coli. Clin Infect Dis 2019;69:182–188.CrossRefGoogle ScholarPubMed
Nickel, KB, Wallace, AE, Warren, DK, Mines, D, Olsen, MA. Using claims data to perform surveillance for surgical site infection: the devil is in the details. In: Battles JB, Cleeman JI, Kahn KK, Weinberg DA, eds. Advances in the Prevention and Control of HAIs. Rockville, MD: Agency for Healthcare Research and Quality (US) Publication No. 14-0003; 2014:169–182.Google Scholar
National Healthcare Safety Network. Surgical site infection (SSI) event. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Published 2015. Accessed June 17, 2019.Google Scholar
HCUP comorbidity software, version 3.7. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality website. http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Published 2014. Accessed June 14, 2021.Google Scholar
Klabunde, CN, Potosky, AL, Legler, JM, Warren, JL. Development of a comorbidity index using physician claims data. J Clin Epidemiol 2000;53:1258–1267.CrossRefGoogle ScholarPubMed
Cook, N. SAS macros. Brigham & Women’s Hospital Division of Preventive Medicine website. http://ncook.bwh.harvard.edu/sas-macros.html. Published 2015. Accessed July 25, 2020.Google Scholar
VanderWeele, TJ, Ding, P. Sensitivity analysis in observational research: introducing the E-Value. Ann Intern Med 2017;167:268–274.CrossRefGoogle ScholarPubMed
Banuelos, J, Abu-Ghname, A, Asaad, M, Vyas, K, Rizwan, MS, Sharaf, B. Microbiology of implant-based breast reconstruction infections: a systematic review. Ann Plast Surg 2020;85:194–201.CrossRefGoogle ScholarPubMed
Viola, GM, Baumann, DP, Mohan, K, et al. Improving antimicrobial regimens for the treatment of breast tissue expander-related infections. Plast Reconstr Surg Glob Open 2016;4:e704.CrossRefGoogle ScholarPubMed
Monroig, K, Ghosh, K, Marquez, JE, et al. Do postoperative prophylactic antibiotics reduce highly virulent infections? An analysis of 660 tissue expander breast reconstructions. Ann Plast Surg 2020;85 suppl 1:S50–S53.CrossRefGoogle Scholar
Brown, KA, Khanafer, N, Daneman, N, Fisman, DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother 2013;57:2326–2332.CrossRefGoogle ScholarPubMed
Geller, AI, Lovegrove, MC, Shehab, N, Hicks, LA, Sapiano, MRP, Budnitz, DS. National estimates of emergency department visits for antibiotic adverse events among adults—United States, 2011–2015. J Gen Intern Med 2018;33:1060–1068.CrossRefGoogle ScholarPubMed
Nickel, KB, Wallace, AE, Warren, DK, et al. Modification of claims-based measures improves identification of comorbidities in nonelderly women undergoing mastectomy for breast cancer: a retrospective cohort study. BMC Health Serv Res 2016;16(a):388.CrossRefGoogle Scholar
Lix, LM, Yogendran, MS, Leslie, WD, et al. Using multiple data features improved the validity of osteoporosis case ascertainment from administrative databases. J Clin Epidemiol 2008;61:1250–1260.CrossRefGoogle ScholarPubMed
Lipscombe, LL, Hwee, J, Webster, L, Shah, BR, Booth, GL, Tu, K. Identifying diabetes cases from administrative data: a population-based validation study. BMC Health Serv Res 2018;18:316.CrossRefGoogle ScholarPubMed
Carrara, G, Scirè, CA, Zambon, A, et al. A validation study of a new classification algorithm to identify rheumatoid arthritis using administrative health databases: case-control and cohort diagnostic accuracy studies. Results from the RECord linkage On Rheumatic Diseases study of the Italian Society for Rheumatology. BMJ Open 2015;5(1):e006029.CrossRefGoogle ScholarPubMed
Supplementary material: File

Warren et al. supplementary material

Warren et al. supplementary material

Download Warren et al. supplementary material(File)
File 61.3 KB