Abstract P6-14-10: A retrospective study of peri-prosthesis infection after prosthesis based breast reconstruction in a single breast center in east China and impact of an evidence-based protocol
Authors: Jian Liu , Jufeng Guo , Shufang Hu , Shijiao Nie , Qiong Chen , Shuying Wang 
Published: March 2020

Abstract
Purpose
To investigate the status of surgical site infection after prosthesis-based breast reconstruction in a single center and evaluate the role of an evidence-based protocol in infection control in immediate prosthesis-based breast reconstruction.
Method
Two cohorts are included in our study. In the first cohort, a retrospective analysis of consecutive post-mastectomy prosthesis-based reconstructions performed between June of 2010 and April of 2018 at Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine was performed. We reviewed clinicopathological information and the surgical outcomes through the medical record and questionnaire. Then we developed an evidence-based perioperative infection prevention protocol marked by preoperative decolonization and sterility optimization according literatures. In the second cohort, patients had undergone prosthesis-based breast reconstruction after protocol implementation between July of 2018 and April of 2019. We compared the surgical outcomes between this two cohort. In this study a patient was considered to have infection if she had any of these: (1) local inflammatory symptoms in breast that requires intravenous antibiotics or surgical intervention, (2) purulent drainage, (3) pathogenic culture positive. Infections requiring surgical intervention were defined as severe infections. T test was used to analyze quantitative data, Fisher’s two-tailed exact test was used to compare qualitative data. A multi-factor logistic regression analysis was used to analyze risk factors.
Results
In the first cohort,108 reconstruction procedures were performed among 93 patients. Median follow-up time was 17.5 months. The infection rate was 23.1%(25/108). Three prosthesis were explanted at postoperative 30 days, 50 days and 15 months respectively. The prosthesis salvage rate and total explantation rate were 88%(22/25), 2.8%(3/108) respectively. Culture was performed in only 17 patients with 24 samples. Pathogens were found in 4 samples: S.aureus(n=2), enterococci(n=1) and serratia marcescens(n=1). The average duration of prophylactic antibiotics was 5.4±3.9 days. Cephalosporin was the main prophylactic antibiotics. Therapeutic antibiotics for infected patients were mainly based on empirical agents, with vancomycin widely used. A multi-factor regression analysis indicated that large volume prothesis (V&gt;400CC) was an independent risk factor of severe infection (p&lt;0.05). After the protocol was implemented, 48 breasts were reconstructed among 45 patients. Median follow-up time was 6.5 months. Only one patient was considered as infection for tissue expander exposure following nipple necrosis. Overall, the rate of infection reduced significantly from 23.1% (25/108) to 2.1%(1/48) (P = 0.001).
Conclusions
Our single center data indicated that incidence of peri-prosthesis infection seems high in medium-sized hospitals in eastern China, but explantation rate is still very low. The evidence-based protocol was associated with a significant decline in infection rates among prosthesis-based breast reconstruction patients.
In addition, there are many urgent problems such as inadequate application of prophylactic antibiotics, poor awareness of bacterial culture. We will continue to use this protocol in our practice to control infection.
Table 1. Schematic of evidence-based protocolPreoperativeIntraoperativePostoperative*nasal swab culture*intravenous cefazolin(swab negative)or vancomycin(swab MRSA)* prophylactic antibiotics for 24 hours* chlorhexidine* chlorhexidine prep*drain removal in 3 weeks after surgery*intranasal mupirocin*glove change*re-draping*prosthesis minimal touch*betadine and antibiotics (cefazolin, gentamicin) irrigation* betadine and antibiotics rinse pocket*dermabond dressing for incision and drains
Citation Format: Liu Jian, Guo Jufeng, Hu Shufang, Nie Shijiao, Chen Qiong, Wang Shuying. A retrospective study of peri-prosthesis infection after prosthesis based breast reconstruction in a single breast center in east China and impact of an evidence-based protocol [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-10.