Background: Breast surgery is considered a clean surgery; however, surgical site infection (SSI) rates are higher than predicted. Postoperative drains remain in situ for several days with an inevitable bacterial colonization and increased risk of SSI.
Methods: We conducted a randomized controlled trial from October 2016 to January 2018 in a Mexican cancer center with high SSI prevalence. We included women with elective breast cancer surgery. Patients were randomized to control (standard drain care) or intervention (occlusive dressing with chlorhexidine 2% at the drain exit site). Perioperative management was standardized for both groups. Patient follow-ups were performed on a weekly basis for at least 30 days. Fluid cultures were performed at the 1st and 2nd week as standardized in the laboratory. At the time of drain removal, the inner portion was sectioned and cultured by Makis semi-quantitative technique. Bacterial quantification was performed using 16 s rRNA-qPCR assay. Culture results of drain fluid and tubing were compared between groups.
Results: We included 104 patients with 167 surgical drains. Patients clinical characteristics (i.e. age, body mass index, comorbidities, clinical stage, preoperative risk, neoadjuvant therapy) were similar in both groups, with no statistical differences. Bulb fluid cultures at the 1st postoperative week were positive in 42.9% of the control group compared to 27.6% of the antiseptic group (p=0.04). Cultures from the 2nd week assessment were positive in 79.4% of the control group vs 53.5% of the antiseptic arm (p=0.001). Cultures from drain-tubes were positive in 70.2% and 43.8% (p=0.001) of the control and antiseptic group, respectively (Figure 1.) Eleven patients developed an SSI, 3 (15.4%) from the intervention group, and 8 (15.8%) from the control group (p=0.11). 84 pathogens were isolated from the control group samples at week 1 vs 52 from the intervention group. Staphylococci spp. were the most common microorganisms in week 1, 61.9% control and 35% intervention group.
Conclusion: Local antiseptics provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization after breast surgery and potentially decrease infectious complications. Our microbiology findings question breast tissue sterility.
Donated the dressings used
C. G. Román-López, None
P. Cornejo-Juárez, None
E. Bargalló-Rocha, None
H. Medina-Franco, None
D. Vilar-Compte, 3M: Donated the dressings used , Research support .