Prevalence and Predictors of Post-Discharge Antibiotic Use Following Mastectomy

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Olsen, Margaret A. ; Nickel, Katelin B. ; Fraser, Victoria J. ; Wallace, Anna E. ; Warren, David K.
• 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.
  
  
• Subjects:
  Adolescent Adult Anti-Bacterial Agents Antibiotic Prophylaxis Cephalosporins Databases, Factual Drug Utilization Female Fluoroquinolones Humans Insurance, Health Mammaplasty Mastectomy Middle Aged Prevalence Retrospective Studies Risk Factors Surgical Wound Infection United States Young Adult

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• Source:
  Infect Control Hosp Epidemiol. 38(9):1048-1054
• Pubmed ID:
  28669356
• Pubmed Central ID:
  PMC5645083
• Document Type:
  Journal Article
• Funding:
  R24 HS019455/HS/AHRQ HHSUnited States/ ; U54 CK000609/CK/NCEZID CDC HHSUnited States/ ; P30 CA091842/CA/NCI NIH HHSUnited States/ ; UL1 TR000448/TR/NCATS NIH HHSUnited States/ ; UL1 TR002345/TR/NCATS NIH HHSUnited States/ ; U54 CK000162/CK/NCEZID CDC HHSUnited States/ ; R01 CA149614/CA/NCI NIH HHSUnited States/
• Volume:
  38
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:c15569e9cf029d312b1f5f4135cb661989181c290471ba2da219ab32249bd656
• Download URL:
  https://stacks.cdc.gov/view/cdc/49173/cdc_49173_DS1.pdf
• File Type:
  [PDF - 133.05 KB ]