Analysistothenecessity Of Perioperative Prophylactic Antibiotic Administration In Female Breast Cancer Patients

Background&Objective:Generally, breast cancer surgery belongs to the category of clean incision surgery and is operated on the sterile body field. Prophylactic use of antibiotics is not always necessary except for high-risk population or in some special circumstances. In clinical practice, the phenomenon of unreasonable perioperative antibiotic usage in breast cancer surgery exits in the domestic hospitals at all levels and abroad, which resulting in growing bacterial resistance and superinfection, more adverse reactions and also increased hospitalization costs. In2011, the Ministry of Health carried out the special campaign about the clinical use of antibiotics across the country, aiming at further standardizing the clinical management and application of antimicrobial agents, thus curbing the bacterial resistance effectively. Therefore, since October2011, our department stopped the routine usage of perioperative prophylactic antibiotics in breast cancer surgery. To a much further extent, we also quit using antimicrobial drugs for patients with older age, comorbidity of diabetes mellitus or breast implantation. In our department, we focus on the implementation of aseptic principle and the strengthening the perioperative nursing. Finally, we achieve satisfactory results in terms of postoperative recovery.In our research, we retrospectively analyze the necessity of the usage of perioperative prophylactic antibiotics to standardize and rationalize the clinical usage of antimicrobial drugs, and we explore the risk factors of surgical site infection to help guiding the medical staff to effectively prevent postoperative infection.Methods:In this study, we collect the data of2056cases of female breast cancer patients, which were hospitalized from January2008to November2013in Breast Surgery, Qilu Hospital of Shandong University. Information concerning the general clinicopathologic characteristics, duration and types of perioperative antibiotics administration, postoperative surgical site infection and postoperative temperature changes are gathered and analyzed. And we aim to determine whether perioperative antibiotic usage is necessary to prevent surgical site infection and which perioperative factors is associated with a higher probability of surgical site infection in breast cancer surgery.Results:A total of2056cases of breast cancer patients were included in this study, with the mean age of49.8years old. Among them,1,022cases didn’t use any antimicrobial drugs in perioperative period for prophylaxis (Group A). Based on patients in Group A, we conducted the analysis of risk factors associated with surgical site infection. Compared with the non-infected group, the infected group had more cases receiving neoajuvant chemotherapy (27.3%vs.5.9%, P=0.026). And there were no significant differences between the remaining variables. The other1034patients did use prophylactic antibiotics to prevent infection (Group B), with the average using time for2.1days. Cephalosporin drugs were most widely used, accounting for86%. Comparing patients in Group A and B, we found that perioperative antibiotic prophylaxis could not decrease the surgical site infection rate.1.1%patients in Group A and1.2%patients in Group B suffered surgical site infection and the difference was not statistically significant (p=0.86). The surgical site infection rate was4.8%for patients receiving neoadjuvant chemotherapy but no antibiotic prophylaxis,0.7%for those receiving both neoadjuvant chemotherapy and antibiotic prophylaxis, and0.8%for those receiving antibiotic prophylaxisbut no neoadjuvant chemotherapy. Compared with the latter two groups, the infection rate is significantly different (P=0.043, P=0.026). Thus, perioperative antibiotic prophylaxis can effectively reduce the incidence of surgical site infection for patients receiving neoadjuvant chemotherapy.We also analyzed the cases with postoperative fever and it showed that patients with the ASA grade Ⅰ/Ⅱ were more prone to experience a slightly increased temperature than those with the ASA grade Ⅲ/Ⅳ. The other variables had no significant relationship with postoperative fever.Conclusion:For female breast cancer patients underwent clean surgical procedure, the surgical site infection rate is1.1%. Patients with elder age, history of diabetes mellitus, malnutrition or longer operation time are not at higher risk of infection and prophylactic antibiotics are not necessary for them. Preoperative neoadjuvant chemotherapy is a significant risk factor of surgical site infection and prophylactic antibiotics is effective in preventing infection for female breast cancer patients.