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-resistant Staphylococcus aureus was 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/m² and the use of an inadequate dose of antibiotics for prophylaxis may increase risk of SSI.

Figure 1

Surgical site infection rate by antibiotic and dose. Rates of SSI in nonreconstructive breast surgery patients were compared by antibiotic and dose. Clindamycin doses^∗ of 150 or 300 mg were combined as ≤300 mg and doses of 450 and 600 mg were combined as >300 mg. The 1-gram cefazolin dose was associated with significantly higher rates of SSI compared to no antibiotic prophylaxis, 13.2% versus 4.0%, p < 0.0001. A ≤300 mg dose of clindamycin was also associated with significantly higher rates of SSI compared to no antibiotics, 15.4% versus 4.0%, p = 0.027.