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Prevalence and Predictors of Post-Discharge Antibiotic Use Following Mastectomy
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9 2017
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Source: Infect Control Hosp Epidemiol. 38(9):1048-1054
[PDF-133.05 KB]
Details:
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Alternative Title:Infect Control Hosp Epidemiol
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Personal Author:
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Description:Objective
Surveys suggest prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of post-discharge prophylactic antibiotics after mastectomy ± immediate breast reconstruction.
Design
Retrospective cohort.
Patients
Commercially insured women aged 18–64 years coded for mastectomy from 1/2004–12/2011. Women with a preexisting wound complication or septicemia were excluded.
Methods
Predictors of prophylactic antibiotics within 5 days after discharge were identified in women with one year prior insurance enrollment; relative risks (RR) were calculated using generalized estimating equations.
Results
12,501 mastectomy procedures were identified, with immediate reconstruction in 7,912 (63.3%). Post-discharge prophylactic antibiotics were used in 4,439 (56.1%) procedures with and 1,053 (22.9%) without immediate reconstruction (p < .001). The most common antibiotics were cephalosporins (75.1%) and fluoroquinolones (11.1%). Independent predictors of post-discharge antibiotics were implant reconstruction (RR 2.41, 95% confidence interval [CI] 2.23, 2.60), autologous reconstruction (RR 2.17, 95% CI 1.93, 2.45), autologous reconstruction plus implant (RR 2.11, 95% CI 1.92, 2.31), hypertension (RR 1.05, 95% CI 1.00, 1.10), tobacco use (RR 1.07, 95% CI 1.01, 1.14), surgery at an academic hospital (RR 1.14, 95% CI 1.07, 1.21), and receipt of home health care (RR 1.11, 95% CI 1.04, 1.18). Post-discharge prophylactic antibiotics were not associated with SSI after mastectomy ± immediate reconstruction (both p > 0.05).
Conclusions
Prophylactic post-discharge antibiotics are common after mastectomy, with immediate reconstruction the strongest predictor. Stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.
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Pubmed ID:28669356
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Pubmed Central ID:PMC5645083
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Funding:
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Volume:38
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Issue:9
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