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Post-Discharge Prophylactic Antibiotics Following Mastectomy With and Without Breast Reconstruction
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10 2022
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Source: Infect Control Hosp Epidemiol. 43(10):1382-1388
[PDF-248.48 KB]
Details:
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Alternative Title:Infect Control Hosp Epidemiol
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Description:Background:
Prophylactic antibiotics are commonly prescribed at discharge for mastectomy, despite guidelines recommending against this practice. We investigated factors associated with post-discharge prophylactic antibiotic use after mastectomy with and without immediate reconstruction (IR) and the impact on surgical site infection (SSI).
Study Design:
We studied a cohort of women aged 18–64 years undergoing mastectomy between 1/1/2010–6/30/2015 using the MarketScan Commercial Database. Patients with non-surgical perioperative infections were excluded. Post-discharge oral antibiotics were identified from outpatient drug claims. SSI was defined using ICD-9-CM diagnosis codes. Generalized linear models were performed to determine factors associated with post-discharge prophylactic antibiotic use and SSI.
Results:
The cohort included 38,793 procedures; 24,818 (64%) with immediate reconstruction. Prophylactic antibiotics were prescribed post-discharge after 2,688 (19.2%) mastectomy only and 17,807 (71.8%) mastectomies with IR. The 90-day incidence of SSI was 3.5% after mastectomy only and 8.8% after mastectomy with IR. Antibiotics with anti-methicillin-sensitive Staphylococcus aureus (MSSA) activity were associated with decreased SSI risk after mastectomy only (adjusted relative risk [aRR], 0.74; 95% confidence interval [CI], 0.55, 0.99) and mastectomy with IR (aRR, 0.80; 95% CI, 0.73, 0.88), respectively. The number needed to treat (NNT) to prevent one additional SSI was 107 and 48, respectively.
Conclusion:
Post-discharge prophylactic antibiotics were common after mastectomy. Anti-MSSA antibiotics were associated with decreased risk of SSI for mastectomy only and mastectomy with IR patients. The high NTTs suggest that potential benefits of post-discharge antibiotics should be weighed against potential harm associated with antibiotic over-use.
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Pubmed ID:34569458
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Pubmed Central ID:PMC8957624
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Volume:43
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Issue:10
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