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Submitted: 08 March 2011 Modified: 09 May 2018
HERDIN Record #: PCHRD03081104033493

Antibiotic prophylaxis in elective breast surgery: A meta-analysis of randomized placebo-controlled trials.

Marizel G. Mallari-Catungal,
Loreto J. Codamos,
Remedios F. Coronel

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Postoperative wound infection after breast surgery may result in significant morbidity, psychological trauma and additional costs. We assessed the efficacy of perioperative antibiotic prophylaxis in elective breast surgery by doing a systematic review (meta-analysis) of three randomized placebo-controlled trials involving a total of 902 patients. The prophylactic regimen used were cefazolin and cefonicid. Types of breast surgery included mastectomies (simple or modified radical), lumpectomies or segmental or simple excisions, axillary lymph node dissections and reduction mammoplasties. Patients in the placebo group (43 out of 452) had significantly higher incidence of postoperative wound infection than in the treatment group (25 out of 450) (9.5 per cent and 5.5 per cent, respectively). The absolute risk reduction (ARR) was 4 per cent (95% CI 0.5% to 7.5%); odds ratio (OR) was 0.57 (95% CI 0.35 to 0.93); and number needed to treat (NNT) was 25 (95% CI 14 to 192 patients, p0.05). Antibiotic prophylaxis significantly reduced the risk of postoperative wound infection elective breast surgery. Further studies are needed to determine the optimum timing, dose and dosage schedule of antibiotic prophylaxis, and compare the effectiveness of different antibiotics.(Author)

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Journal of Surgical Specialties
Frequency
Quarterly
Publication Date
January-March 2000
Volume
55
Issue
1
Page(s)
30-33
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Fulltext pdf (Request Document)
1. Condon, R E, Wittman, D H. "The use of antibiotics in general surgery" Curr Probl Surg 28, 803-907, 1991
2. Haley, R W, Calver, D H, Whit, J W. "The nationwide nosocomial infection rate : a new need for vital statistics" Am J Epidemiol 121(159-167): 1985
3. Budd, D C, Cochran, R C, Sturtz, D L, Fouty, W J. "Surgical morbidity after mastectomy operations" Am J Surg 135, 218-220, 1978
4. Platt, R , Zaleznik, D F, Hopkins, C C, Dellinger, E P, Karchmer, A W, Bryan, J F. "Perioperative antibiotic prophylaxis for herniorrphaphy and breast surgery" New Eng J Med 322, 153-160, 1990. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/2403655
5. Lewis , R T, Weigand, F M, Mammazza, J , Lloyd-Smith, W , Tataryn, D . "Should antibiotic prophylaxis be used routinely in clean surgical procedures : a tentative yes" Surgery 118(4): 742-747, 1995. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=Should%20antibiotic%20prophylaxis%20be%20used%20routinely%20in%20clean%20surgical%20procedures%20%3A%20a%20tentative%20yes
6. Platt, R , Zucker, J R, Zaleznik, D F, Hopkins, C C, Dellinger, A W, Karchmer, A W. "Perioperative antibiotic prophylaxis and wound infection following breast surgery" J Antimicrob Chemother 31 (Suppl , 43-48, 1993
7. Wagman, L D, Tegtmeier, B , Beatty, J D, Kloth, D D, Kokal, W A, Riihimaki, D U. "A prospective randomized double-blind study of the use of antibiotics at the time of mastectomy" Surg Gynecol Obstet 170(1): 12-16, 1990
8. Bold, R J, Mansfield, P F, Berger, D H, Pollock, R E, Singletary, S E, Ames, F C. "Prospective, randomized double-blind study of prophylactic antibiotics in axillary lymph node dissection" Am J Surg 176(3): 239-243, 1998. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=Prospective%2C%20randomized%20double-blind%20study%20of%20prophylactic%20antibiotics%20in%20axillary%20lymph%20node%20dissection
9. Platt, R , Zucker, J R, Zaleznik, D F, Hopkins, C C, Dellinger, E P. "Prophylaxis against wound infection following herniorraphy on breast surgery" J Infect Dis 166, 556-560, 1992. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=Prophylaxis%20against%20wound%20infection%20following%20herniorraphy%20on%20breast%20surgery
10. Thomas, R , Alvino, P , Cortina, G R, Accardo, R . "Long-acting versus short-acting cephalosporins for preoperative prophylaxis in breast surgery : a randomized double-blind trial involving 1,766 patients" Chemotheraphy 45(3): 217-223, 1999. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=Long-acting%20versus%20short-acting%20cephalosporins%20for%20preoperative%20prophylaxis%20in%20breast%20surgery%20%3A%20a%20randomized%20double-blind%20trial%20involving%201%2C766%20patients
11. Leaper, D J. "Risk factors for surgical infections" J Hosp Infect 30 (Suppl., 127-139, 1995
12. Clarke, J S, Condon, R E, Bartlett, J G, Gorbach, S L, Nichols, R L, Ochi, S . "Preoperative oral antibiotics reduce septic complications of colon operations : results of prospective, randomized, double-blind clinical study" Ann Surg 186, 251-259, 1977. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/889372
13. Hill, C , Flamant, R , Mazas, F , Evrard, J . "Prophylactic cefazolin versus placebo in total hip replacement" Lancet 1, 795-796, 1981. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/6111670
14. Kaiser, A B, Petracek, M R, Lea, J W. "Efficacy of cefazolin, cefamandole and gentamicin as prophylactic agents in cardiac surgery : results of a prospective, randomized, double-blind trial in 1030 patients" Ann Surg 206, 791-797, 1987. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=Efficacy%20of%20cefazolin%2C%20cefamandole%20and%20gentamicin%20as%20prophylactic%20agents%20in%20cardiac%20surgery%20%3A%20results%20of%20a%20prospective%2C%20randomized%2C%20double-blind%20trial%20in%201030%20pati
15. Hopkins, C C. "Antibiotic prophylaxis in clean surgery: peripheral vascular surgery, non-cardiothoracic surgery, herniorrhaphy and mastectomy" Rev Infect Dis 13(Suppl), S869-873, 1991. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed?term=Antibiotic%20prophylaxis%20in%20clean%20surgery%3A%20peripheral%20vascular%20surgery%2C%20non-cardiothoracic%20surgery%2C%20herniorrhaphy%20and%20mastectomy