Antibiotic Prophylaxis for Preventing Wound Infection after Breast Surgery: A Systematic Review and Metaanalysis

The accepted rate for wound infections after clean operations is approximately 1.5%. 1 But there are studies that have shown a higher incidence of wound infections after breast operations, ranging from 3% to 30%. 2-8 One study reported an infection rate as high as 62.5% for patients undergoing mastectomy after a lumpectomy. 2 These surprisingly high rates of postoperative infections after breast surgery provide the impetus for consideration of antibiotic prophylaxis even though breast operations are considered clean. Aside from the consequences universal to all postoperative infections, such as the cost of treating an infection including antibiotics, additional nurse or doctor visits, potential hospitalization, and time lost from work, postoperative breast infections should be considered unique for several reasons. Wound infections after breast surgery can have severe consequences, such as poor cosmesis and in the case of breast cancer, can delay subsequent adjuvant chemotherapy and radiation therapy. It has been shown that delaying adjuvant therapy results in worse outcomes for patients with breast cancer. 3,9 These unique consequences also make any attempt to reduce infection rate an important goal. The available data in the literature have not sufficiently answered the question of whether prophylactic antibiotics truly decrease postoperative breast infections. The primary objective of this systematic review and metaanalysis was to determine the efficacy of antibiotic prophylaxis on reducing wound infections in adult patients undergoing breast operations. Adverse reactions of the antibiotic prophylaxis were a secondary objective. METHODS Data sources All trials comparing preoperative antibiotics versus placebo were searched using Medline from 1966 to present and the Cochrane Library using the terms breast and infection, limited to human studies and randomized controlled trials (RCTs). One additional study was found using the search similar studies in PubMed for selected articles. In addition, a manual search was performed using the reference list in selected articles. No language restriction was applied.