TY - JOUR
T1 - Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction
AU - CDC Prevention Epicenter Program
AU - Warren, David K.
AU - Peacock, Kate M.
AU - Nickel, Katelin B.
AU - Fraser, Victoria J.
AU - Olsen, Margaret A.
N1 - Funding Information:
M.A.O. reports consultant work and grant funding from Pfizer outside the submitted manuscript. V.J.F. reports that her spouse is the Chief Clinical Officer at Cigna Corporation. D.K.W. reports consultant work with Centene, PDI, Pursuit Vascular, and Homburg & Partner, and he is a subinvestigator for a Pfizer-sponsored study for work outside the submitted manuscript. All other authors report no conflicts of interest relevant to this article.
Funding Information:
Funding for this project was provided by the Centers for Disease Control and Prevention (grant no. U54CK000482 VJF). The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences (grant no. UL1 TR002345) from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ grant no. R24 HS19455). The funding sources were not involved in the conduct of the study.
Publisher Copyright:
©
PY - 2022/10/27
Y1 - 2022/10/27
N2 - Background: Prophylactic antibiotics are commonly prescribed at discharge for mastectomy, despite guidelines recommending against this practice. We investigated factors associated with postdischarge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). Study design: We studied a cohort of women aged 18-64 years undergoing mastectomy between January 1, 2010, and June 30, 2015, using the MarketScan commercial database. Patients with nonsurgical perioperative infections were excluded. Postdischarge oral antibiotics were identified from outpatient drug claims. SSI was defined using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnosis codes. Generalized linear models were used to determine factors associated with postdischarge prophylactic antibiotic use and SSI. Results: The cohort included 38,793 procedures; 24,818 (64%) with immediate reconstruction. Prophylactic antibiotics were prescribed after discharge after 2,688 mastectomy-only procedures (19.2%) and 17,807 mastectomies with immediate reconstruction (71.8%). The 90-day incidence of SSI was 3.5% after mastectomy only and 8.8% after mastectomy with immediate reconstruction. Antibiotics with anti-methicillin-sensitive Staphylococcus aureus (MSSA) activity were associated with decreased SSI risk after mastectomy only (adjusted relative risk [aRR], 0.74; 95% confidence interval [CI], 0.55-0.99) and mastectomy with immediate reconstruction (aRR, 0.80; 95% CI, 0.73-0.88), respectively. The numbers needed to treat to prevent 1 additional SSI were 107 and 48, respectively. Conclusions: Postdischarge prophylactic antibiotics were common after mastectomy. Anti-MSSA antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. The high numbers needed to treat suggest that potential benefits of postdischarge antibiotics should be weighed against potential harms associated with antibiotic overuse.
AB - Background: Prophylactic antibiotics are commonly prescribed at discharge for mastectomy, despite guidelines recommending against this practice. We investigated factors associated with postdischarge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). Study design: We studied a cohort of women aged 18-64 years undergoing mastectomy between January 1, 2010, and June 30, 2015, using the MarketScan commercial database. Patients with nonsurgical perioperative infections were excluded. Postdischarge oral antibiotics were identified from outpatient drug claims. SSI was defined using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnosis codes. Generalized linear models were used to determine factors associated with postdischarge prophylactic antibiotic use and SSI. Results: The cohort included 38,793 procedures; 24,818 (64%) with immediate reconstruction. Prophylactic antibiotics were prescribed after discharge after 2,688 mastectomy-only procedures (19.2%) and 17,807 mastectomies with immediate reconstruction (71.8%). The 90-day incidence of SSI was 3.5% after mastectomy only and 8.8% after mastectomy with immediate reconstruction. Antibiotics with anti-methicillin-sensitive Staphylococcus aureus (MSSA) activity were associated with decreased SSI risk after mastectomy only (adjusted relative risk [aRR], 0.74; 95% confidence interval [CI], 0.55-0.99) and mastectomy with immediate reconstruction (aRR, 0.80; 95% CI, 0.73-0.88), respectively. The numbers needed to treat to prevent 1 additional SSI were 107 and 48, respectively. Conclusions: Postdischarge prophylactic antibiotics were common after mastectomy. Anti-MSSA antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. The high numbers needed to treat suggest that potential benefits of postdischarge antibiotics should be weighed against potential harms associated with antibiotic overuse.
UR - http://www.scopus.com/inward/record.url?scp=85116585689&partnerID=8YFLogxK
U2 - 10.1017/ice.2021.400
DO - 10.1017/ice.2021.400
M3 - Article
C2 - 34569458
AN - SCOPUS:85116585689
SN - 0899-823X
VL - 43
SP - 1382
EP - 1388
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 10
ER -