The Evolution of Breast Implant Infections: Serratia marcescens Is an Emerging Pathogen in Implant-Based Breast Reconstruction

Abstract

The flora of implant-based breast infections has changed over the last decade, including at our institution. A 10-year retrospective chart review was performed on 561 implant-based breast reconstructions in 378 patients performed by a single surgeon in an academic university hospital setting. Thirty-two breast infections requiring explantation of the implants occurred during those 10 years. During that time frame, a new pre- and peri-operative protocol was implemented in an effort to diminish infections. We believe that this protocol played a major role in the evolution of changing breast periprosthetic infection flora, from nearly one-third being gram-negative infections to 100% being gram-negative infections. Gram-negative antibiotic coverage should be considered in light of these evolving trends to prevent infections particularly with Serratia marcescens. This may be especially important in patients with BRCA1/2 or ATM mutations. Diabetic patients are more likely to develop Methicillin-resistant Staphylococcus aureus (MRSA) infections and preoperative MRSA decolonization is essential in these patients. Many patients have late-onset breast periprosthetic infection, the majority of which occurred after 30 days. Regular follow-up and patient education is important to provide timely treatment.

Keywords: MRSA infection; Serratia marcescens; breast implant; breast periprosthetic infection; gram-negative infection; implant infection; infectious flora of breast implant.

Figure 1.

Number and percentage of gram-positive, gram-negative, and sterile cultures from breast periprosthetic infections during pre- versus post-protocol period (2007-2015 vs 2015-2016).