Methods: From Jan 1, 2013-Oct 30, 2015, patients with culture proven superficial or deep incisional SSIs based on NHSN criteria were identified through the infection control surveillance system and categorized by procedure code (CPT code). Preoperative bathing with chlorhexidine and pre-op cefazolin (clindamycin vs fluoroquinolone in PCN allergic patients) are standard of care. Patient demographic information, reconstruction characteristics, microbiological data and postsurgical antibiotic prophylaxis were reviewed (Table 1). Epidemiologically related infections due to the same species were molecularly characterized to evaluate common source infections.
Results: During the 22 month study period, 2340 patients underwent surgery, 69 (2.95%) developed culture proven SSI. All the patients were female. Overall infection rates in biologic vs prosthetic reconstruction were not significantly different (29 vs 21 per 1000 procedures). Gram-positives (MSSA, 44.9%; MRSA 11.6%) were most common. Among gram negatives, PSAE was the dominant organism. CONS although common was mostly found in polymicrobial culture. The majority of monomicrobial infections were caused by MSSA. No common sources were identified by PFGE characterization of temporally related MRSA and PSAE isolates.
Conclusion: The rate of culture proven infection among our cohort of over 2300 patents was 2.95%. Gram-positive organisms accounted for the majority of SSIs following breast reconstructive surgery. Among gram negatives, Pseudomonas was the most common organism. Genotyping of organisms from temporally related infections identified sporadic strains without evidence of clonal spread.
|Types of Reconstruction|
|Post-procedure Antibiotic Prophylaxis|
Cephalosporin Clindamycin Levofloxacin None specified
J. Brite, None
J. Disa, None
M. Kamboj, None
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