Abstract P2-14-11: Antibiotic prophylaxis in prosthesis-based mammoplasty: A systematic review
Authors: Huang Naisi , Liu Mengying , Wu Jiong 
Published: May 2015

Abstract
Background Implants are used in over two-thirds of breast reconstructions and all aesthetic augmentations. Although considered as an aseptic surgery, infection rate after prosthesis-based breast surgery is reported to be 2% to 2.5% of patients and represents the leading cause of morbidity after reconstructive and aesthetic surgery. Therefore, prophylactic antibiotics is supported by several studies to prevent surgical site infection (SSI) and capsular contracture (CC). However, there is no high quality evidence on antibiotic prophylaxis in prosthesis-based mammoplasty.
Methods An electronic search was conducted in Medline, Embase, and Cochrane. Studies of prosthesis-based breast surgery with control group and antibiotic prophylaxis were included. Two authors independently screened, assessed and then extracted information from the included studies. Mantel-Haenszel method was used to conduct meta-analysis. All analysis was performed by STATA 12.0. Studies that were not qualified to be included into meta-analysis were summarized and described.
Results 15 studies were included into analysis. Average Jaded score for RCT studies was 2.5 (1-4). Average Newcastle score for non RCT studies was 7.55 (4-9). 3 studies compared systematic antibiotic prophylaxis with no antibiotic use, while no significant difference was observed. Compared with antibiotic prophylaxis within 24 hours, extended systematic antibiotic prophylaxis more than 24 hours postoperatively could significantly reduce infection rate (RR=0.638, CI 0.453-0.898). The average SSI rate was 4.6% in extended antibiotic group versus 11.1% in control group. 15.38 patients needed to be treated to prevent 1 case of SSI. However, in subgroup analysis, extended antibiotic prophylaxis could significantly decrease SSI rate in implant reconstruction surgery (RR=0.508, CI 0.349-0.739), but not in aesthetic breast surgery (RR=1.458, CI 0.602-3.528). Topical antibiotic irrigation could reduce CC rate (RR=0.472, CI 0.316-0.707), while might not be able to reduce infection rate. The average CC rate was 4.86% in topical antibiotic prophylaxis group, versus 6.81% in control group. 51.28 patients needed to be treated to prevent 1 case of Baker grade III or IV CC. Cephalosporins were the most commonly preferred antibiotic regimen in included studies. Nevertheless, there was no consensus of antibiotic prophylaxis combination or timing.
Conclusions Extended systematic antibiotic prophylaxis will significantly reduce SSI rate, especially in implant breast reconstruction. Topical antibiotic irrigation would decrease CC rate, while might not be able to reduce infection rate. Cephalosporins are generally recommended as antibiotic prophylactic regimen which cover the most commonly identified implant–associated bacteria. Risk factors such as chest irradiation and diabetes should be take into consideration when prescribing antibiotic prophylaxis. More better-designed RCTs are awaited to demonstrate the proper antibiotic regimen in prosthesis-based breast surgery to reduce complications.
Citation Format: Naisi Huang, Mengying Liu, Jiong Wu. Antibiotic prophylaxis in prosthesis-based mammoplasty: A systematic review [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-14-11.