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Antibiotic prophylaxis: current recommendations in plastic surgery

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Guidelines for prophylactic antibiotics in surgery have long been established; however, few have focused on recommendations in plastic surgery. Surgical site infection rates remain low, yet the use of prophylactic antibiotics has surged in the past 30 years. This article summarizes current recommendations of prophylactic antibiotic use to produce consensus guidelines in plastic surgery.

Methods

A literature review was conducted in the PubMed, Cochrane, and Ovid databases and studies were included if randomized controlled trials indicated a statistically significant decrease in surgical site infections. Surveys conducted by the American Society of Plastic Surgeons regarding prophylactic antibiotic use from 1975, 1985, 2000, and 2010 were compiled and analyzed.

Results

Of 143 articles found, nine randomized controlled trials showed a reduction in surgical site infections after antibiotic prophylaxis for specific plastic surgery procedures. There are evidence-based recommendations for prophylactic antibiotics in breast surgery, abdominoplasty, contaminated hand or face surgery, prosthetic surgery, rhinoplasty, microsurgery, and acute and burn reconstruction cases. The proportion of plastic surgeons using prophylactic antibiotics has steadily increased from 1975 to 2010 with a significant increase from 2000 to 2010.

Conclusions

Systemic antibiotic prophylaxis is recommended for use in breast surgery, abdominoplasty, contaminated hand or face surgery, prosthetic surgery, rhinoplasty, microsurgery, and acute and burn reconstruction cases. Recent surveys indicate that the majority of plastic surgeons continue to use prophylactic antibiotics in clean cases of the hand, face, and body despite recommendations. Additional procedure-specific randomized controlled trials are necessary to provide evidence-based recommendations for antibiotic prophylaxis in plastic surgery.

Level of Evidence: Level IV, risk / prognostic study

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Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA

    Shana S. Kalaria, J. Michael Smith & Eric L. Cole

  2. Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Thanapoom Boonipat

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  1. Shana S. Kalaria
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  2. Thanapoom Boonipat
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Correspondence to Eric L. Cole.

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Shana S. Kalaria, Thanapoom Boonipat, J. Michael Smith, and Eric L. Cole declare that they have no conflict of interest.

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Kalaria, S.S., Boonipat, T., Michael Smith, J. et al. Antibiotic prophylaxis: current recommendations in plastic surgery. Eur J Plast Surg 42, 481–488 (2019). https://doi.org/10.1007/s00238-018-1492-2

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  • DOI: https://doi.org/10.1007/s00238-018-1492-2

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