Beyond CDC-Defined Surgical Site Infection: Factors Associated with Antibiotic Prescription After Breast Operation

Corey K Gentle; Moustafa Moussally; Jenny H Chang; Hanna Hong; Kelly Walker; Kelly Nimylowycz; Sayf Al-Deen Said; Zahraa Al-Hilli

doi:10.1089/sur.2024.145

Beyond CDC-Defined Surgical Site Infection: Factors Associated with Antibiotic Prescription After Breast Operation

Surg Infect (Larchmt). 2024 Nov 6. doi: 10.1089/sur.2024.145. Online ahead of print.

Authors

Corey K Gentle¹, Moustafa Moussally¹, Jenny H Chang¹, Hanna Hong², Kelly Walker³, Kelly Nimylowycz³, Sayf Al-Deen Said³, Zahraa Al-Hilli¹

Affiliations

¹ Division of Breast Surgery, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.
² School of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
³ Quality Improvement & Patient Safety, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.

PMID: 39504129
DOI: 10.1089/sur.2024.145

Abstract

Background: Most studies on surgical site infections (SSIs) use the US Centers for Disease Control and Prevention (CDC) guidelines, which excludes inflammation or cellulitis without fever. The aim of this study was to evaluate antibiotic prescription trends in the post-operative period among patients undergoing breast operation. We explore the outcomes of patients receiving antibiotic agents outside of the CDC-defined SSI. Patients and Methods: A retrospective review of patients undergoing breast operation from January 2021 to May 2021 was conducted. Solely reconstructive and cosmetic cases were excluded. The primary outcome was the prevalence of antibiotic prescription in the absence of CDC-defined SSI, excluding routine prophylactic antibiotic agents, with analysis of associated factors. Results: A total of 754 breast surgical procedures were included. Seventy-seven patients (10.2%) were prescribed outpatient antibiotic agents. CDC-defined SSI occurred in 5.3% (n = 40), mostly involving tissue expander/implant-based reconstruction (47.5%, n = 19). However, 37 (4.9%) did not progress to meet the CDC criteria for SSI. Patients prescribed outpatient antibiotic agents without CDC-defined SSI did not have increased rates of diabetes mellitus, obesity, or current smoking. These patients were more likely to have a surgical drain (48.6% vs. 28.4%, p = 0.02), plastic surgery involvement (32.4% vs. 18.0%, p = 0.048), and a post-operative seroma (32.4% vs. 8.1%, p < 0.001) and or or cellulitis (18.9% vs. 0%, p < 0.001). Conclusion: Patients are prescribed antibiotic agents after breast operation based on clinical judgment for indications other than CDC-defined SSI. Post-operative wound morbidity including seroma and cellulitis could be contributing to these antibiotic prescriptions. Further study is needed to determine whether providers are preemptively treating SSIs appropriately or over-treating non-infectious wound complications.

Keywords: antibiotic agents; breast operation; post-operative complications; surgical site infection.