Abstract：
BACKGROUND: Current guidelines in the United States require reporting only the 30-day postoperative outcomes to standardized databases, including the National Surgical Quality Improvement Program (NSQIP). Thus, many breast implant-related complications go unreported in standard databases. We sought to characterize late periprosthetic infections following implant-based breast reconstruction.
METHODS: We conducted a retrospective analysis of all women who underwent expander/implant reconstruction from 2005 to 2014 at two institutions. All periprosthetic infections were identified and divided into early and late cohorts (≤30 days or >30 days). Infection was defined as any episode where antibiotics were initiated or a prosthetic device was explanted because of clinical evidence of the infection.
RESULTS: In the 1820 patients (2980 breasts) identified, 421 periprosthetic infections occurred (14%). Of these, 173 (41%) were early and 248 (59%) were late (mean time to infection = 66.4 ± 101.9 days). Patients with late infections were more likely to be current smokers or have diabetes than patients with early infections (p < 0.034 for both). Infections caused by gram-negative bacteria and antimicrobial-resistant strains of Staphylococcus were more common in the early infection group (p < 0.001 for both). Implant loss due to infection was more common in the late infection group (p = 0.037).
CONCLUSIONS: Late periprosthetic infections following implant-based breast reconstruction are underestimated in national outcome databases and have unique risk factors and microbiology compared to early infections. A system-level change in reevaluating and redefining a timeline for tracking and treating implant infections is necessary, given the substantial morbidity associated with, and frequency of, late periprosthetic infections.
METHODS: We conducted a retrospective analysis of all women who underwent expander/implant reconstruction from 2005 to 2014 at two institutions. All periprosthetic infections were identified and divided into early and late cohorts (≤30 days or >30 days). Infection was defined as any episode where antibiotics were initiated or a prosthetic device was explanted because of clinical evidence of the infection.
RESULTS: In the 1820 patients (2980 breasts) identified, 421 periprosthetic infections occurred (14%). Of these, 173 (41%) were early and 248 (59%) were late (mean time to infection = 66.4 ± 101.9 days). Patients with late infections were more likely to be current smokers or have diabetes than patients with early infections (p < 0.034 for both). Infections caused by gram-negative bacteria and antimicrobial-resistant strains of Staphylococcus were more common in the early infection group (p < 0.001 for both). Implant loss due to infection was more common in the late infection group (p = 0.037).
CONCLUSIONS: Late periprosthetic infections following implant-based breast reconstruction are underestimated in national outcome databases and have unique risk factors and microbiology compared to early infections. A system-level change in reevaluating and redefining a timeline for tracking and treating implant infections is necessary, given the substantial morbidity associated with, and frequency of, late periprosthetic infections.
摘要：
背景：美国目前的指南只要求将术后30天的结果报告给标准化的数据库，包括国家外科质量改进计划（NSQIP）。因此，标准数据库中未报道许多与乳房植入相关的并发症.我们试图表征基于植入物的乳房重建后的晚期假体周围感染。
方法：我们对2005年至2014年在两个机构接受扩张器/植入物重建的所有女性进行了回顾性分析。确定所有假体周围感染，并分为早期和晚期组（≤30天或>30天）。感染定义为由于感染的临床证据而开始使用抗生素或植入假体装置的任何事件。
结果：在1820名患者（2980名乳房）中，发生了421例假体周围感染(14%)。其中,173例（41％）早期，248例（59％）晚期（平均感染时间=66.4±101.9天）。晚期感染的患者比早期感染的患者更可能是目前的吸烟者或患有糖尿病（两者的p<0.034）。革兰阴性菌和葡萄球菌耐药菌株引起的感染在早期感染组更为常见(均p<0.001)。在晚期感染组中，由于感染引起的植入物损失更为常见（p=0.037）。
结论：在国家结果数据库中，基于植入物的乳房重建后的晚期假体周围感染被低估，并且与早期感染相比具有独特的风险因素和微生物学。在重新评估和重新定义跟踪和治疗植入物感染的时间表时，系统级的变化是必要的，考虑到与之相关的大量发病率，和频率，晚期假体周围感染。
方法：我们对2005年至2014年在两个机构接受扩张器/植入物重建的所有女性进行了回顾性分析。确定所有假体周围感染，并分为早期和晚期组（≤30天或>30天）。感染定义为由于感染的临床证据而开始使用抗生素或植入假体装置的任何事件。
结果：在1820名患者（2980名乳房）中，发生了421例假体周围感染(14%)。其中,173例（41％）早期，248例（59％）晚期（平均感染时间=66.4±101.9天）。晚期感染的患者比早期感染的患者更可能是目前的吸烟者或患有糖尿病（两者的p<0.034）。革兰阴性菌和葡萄球菌耐药菌株引起的感染在早期感染组更为常见(均p<0.001)。在晚期感染组中，由于感染引起的植入物损失更为常见（p=0.037）。
结论：在国家结果数据库中，基于植入物的乳房重建后的晚期假体周围感染被低估，并且与早期感染相比具有独特的风险因素和微生物学。在重新评估和重新定义跟踪和治疗植入物感染的时间表时，系统级的变化是必要的，考虑到与之相关的大量发病率，和频率，晚期假体周围感染。
