1165. Breast infections following mastectomy and reconstruction in breast oncology patients.
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
Background: Many organisms have been implicated in post-operative SSIs following breast reconstruction. We report on the microbial species encountered after breast reconstructive surgery at a large tertiary care cancer center.

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.

Table 1.
Age
Median 49  (range 28-84)
Laterality
Left 16 23.2%
Right 17 24.6%
Bilateral  39 52.2%
Types of Reconstruction 
Biologic 13 18.8%
Prosthetic 56 81.2%
Organism
CONS
MRSA
MSSA
MYCO
PSAE
Post-procedure Antibiotic Prophylaxis
Cephalosporin 51 73.9%
Clindamycin 6 8.7%
Levofloxacin 7 10.1%
None specified 5 7.2%

Cephalosporin Clindamycin Levofloxacin None specified

Elizabeth Robilotti, MD MPH1, Christopher Calero, BS2, Jennifer Brite, MPH2, Joseph Disa, MD3 and Mini Kamboj, MD2, (1)Infectious Diseases/Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, (2)Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, (3)Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY

Disclosures:

E. Robilotti, None

C. Calero, None

J. Brite, None

J. Disa, None

M. Kamboj, None

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