Oral Antibiotics Do Not Prevent Infection or Implant Loss after Immediate Prosthetic Breast Reconstruction

Background:Infectious complications following implant-based postmastectomy breast reconstruction (PMBR) are a significant cause of morbidity. Nationwide, antimicrobial stewardship efforts have sought to reduce the use of prophylactic antibiotics postoperatively. However, there are conflicting data regarding the utility of extended antibiotic prophylaxis (EAP) after PMBR, and many surgeons continue to prescribe them. Methods:The authors conducted a retrospective study of 1077 women who underwent immediate prosthetic PMBR from January of 2008 to May of 2020. All patients received intravenous antibiotics preoperatively and up to 24 hours postoperatively. Before October of 2016, patients were also prescribed oral antibiotics until drain removal; thereafter, this practice was abandoned. Ninety-day outcomes were compared between EAP-positive and EAP-negative patients. Descriptive statistics and multivariable logistic regression analysis were used to assess the efficacy of EAP in preventing infection-related complications. Results:There were 1004 breasts in the EAP-positive group and 683 in the EAP-negative group. Three hundred sixty-one reconstructions (21.4%) were prepectoral. Multivariable analysis demonstrated no difference in surgical-site infection (OR, 0.83; 95% CI, 0.56 to 1.25; P = 0.38), admission (OR, 0.78; 95% CI, 0.41 to 1.48; P = 0.44), reoperation (OR, 1.01; 95% CI, 0.68 to 1.48; P = 0.97), or explantation rates (OR, 1.06; 95% CI, 0.66 to 1.71; P = 0.81) between the EAP groups. The EAP-positive group was more likely to develop Gram-negative infections (P < 0.001). Thirteen EAP-positive women (2.0%) developed allergic reactions, and four (0.6%) developed Clostridium difficile colitis attributable to the EAP. Conclusions:EAP after PMBR did not improve outcomes. Although use of EAP did not appear to worsen clinical outcomes, marked differences in the microbiology of associated infections may render them more difficult to treat. Moreover, a small but significant proportion of women experienced adverse reactions to the EAP.