Issue link: https://viewer.e-digitaledition.com/i/100763
cliNical diScuSSioN Postoperative Prophylactic Antibiotics ��� an ounce of Prevention a new sTudy indicaTes wiThholding perioperaTive prophylacTic anTibioTics for breasT reconsTrucTion surgery may lead To fuTure infecTions. R e S e a R c H e R S at t H e Universit y of North Carolina at Chapel Hill Division of Plastic and Reconstructive Surgery recently published a study addressing how changes in antibiotic prophylaxis regimens prior to surgery correlate with increased rates of surgical-site infections in breast reconstruction patients. Sparked by a trend among medical practitioners towa rd limiting perioperative prophylactic antibiotics in nonplastic surgery patients, the authors of the retrospective study adhered to antibiotic prescribing guidelines based on the Surgical Care Improvement Project (SCIP). Sponsored by the Centers for Medicare & Medicaid Services and other national partners, SCIP focuses on improving surgical care by significantly reducing surgical complications throughout hospitals across the United States. Researchers tracked a total of 250 women with surgical-site infections who were categorized according to the way it was treated. The Pre-Surgical Care Improvement Project group with infections were given oral antibiotics only, while the SCIP group received only preoperative and possibly intraoperative antibiotics in accordance with the SCIP guidelines. The study found patients from the PreSurgical Care Improvement Project group experienced an overall increase in surgical infections, from 18.1% to 34.3%. Certain preexisting factors, such as obesity, history of radiation therapy and reconstruction with tissue expanders, were also associated with increased rates of surgical-site infection requiring reoperation. The rate of infection requiring reoperation increased in the Pre-Surgical Care Improvement Project who received a single dose of preoperative prophylactic group, over that of the SCIP group who received numerous doses of antibiotics. Proactive Prevention For one in 10 newly diagnosed breast cancer cases, mastectomies are a popular treatment approach. Because infections of the surgical wound are a common complication following surgery, many surgeons prefer to administer intravenous preopertative prophylactic antibiotics (IPPAs) in an effort to significantly reduce the chances of developing infections. ��� ���i wouldn���t say prophylactic postoperative antibiotics are the standard. i think in certain types of cases, i would be willing to forego them. However, when i���m dealing with an immunocompromised cancer patient with a new prosthetic device, likely in the face of other comorbid conditions, i will rely on postoperative prophylactic antibiotics as a bit of a security blanket.��� ��� carmen m. kavali, m.d., board-certi���ed plastic surgeon at kavali Plastic Surgery in atlanta 16 | Central New York MD News ��� mdNewS.com