Evanston, IL—The use of oral antibiotic prophylaxis beyond 24 hours after surgery remains a common practice among plastic surgeons, with 57% to 85% of patients continuing to receive prescriptions and 79% to 84% of surgeons prescribing antibiotics for at least 3 days postoperatively, according to a new study.

That has continued despite concerns that the benefits fail to outweigh the risks. The research published in Plastic and Reconstructive Surgery—the official medical journal of the American Society of Plastic Surgeons—could potentially be practice-changing, however.

The researchers reported that extended antibiotic prophylaxis (EAP) after implant-based postmastectomy breast reconstruction (PMBR) does not improve outcomes.

“Our experience suggests that discontinuing routine oral antibiotic treatment after implant-based breast reconstruction does not lead to an increase in surgical site infections and will eliminate a small but significant risk of allergy and other antibiotic-related complications,” noted lead author Mark Sisco, MD, of NorthShore University Health System in Evanston, Illinois.

With an increasing number of breast cancer patients undergoing breast reconstruction after mastectomy, especially immediate reconstruction using implants, concerns are heightened about surgical-site infections. Those occur in 10% to 25% of patients undergoing the procedure and can lead to hospital readmission, repeat surgery, and reconstructive failure.

Many health systems have ended routine EAP for postmastectomy breast reconstruction because of concerns about its effectiveness and antibiotic resistance, the authors noted.

The study team conducted a retrospective study of 1,077 women who underwent immediate prosthetic PMBR from January 2008 to May 2020. All patients received IV antibiotics preoperatively and up to 24 hours postoperatively. Before October 2016, patients were also prescribed oral antibiotics until drain removal, although the practice was abandoned.

The researchers compared 90-day outcomes between EAP-positive (representing 1,004 breasts) and EAP-negative (representing 683 breasts) in patients; 361 reconstructions (21.4%) were prepectoral.

The results from multivariable analysis demonstrated no difference in surgical-site infection (odds ratio [OR] 0.83; 95% CI, 0.56-1.25, P = .38); admission (OR, 0.78; 95% CI, 0.41-1.48, P = .44); reoperation (OR 1.01; 95% CI, 0.68-1.48, P = .97); or explantation rates (OR 1.06; 95% CI, 0.66-1.71, P = .81) between the EAP groups.

“The EAP-positive group was more likely to develop gram-negative infections (P <.001),” the authors pointed outed. “Thirteen EAP-positive women (2.0%) developed allergic reactions, and four (0.6%) developed Clostridium difficile colitis attributable to the EAP.”

The study concluded that 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,” the researchers advised.

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