Abstract
Background
In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction.
Methods
With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: chlorhexidine disc dressing at drain exit site(s) and irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution. Cultures were obtained from bulb fluid at 1 week and at drain removal, and from the subcutaneous drain tubing at removal. Positive cultures were defined as ≥1+ growth for fluid and >50 CFU for tubing.
Results
Cultures of drain bulb fluid at 1 week (the primary endpoint) were positive in 9.9 % of treatment sides (10 of 101) versus 20.8 % (21 of 101) of control sides (p = 0.02). Drain tubing cultures were positive in 0 treated drains versus 6.2 % (6 of 97) of control drains (p = 0.03). Surgical site infection occurred within 30 days in 0 antisepsis sides versus 3.8 % (4 of 104) of control sides (p = 0.13), and within 1 year in three of 104 (2.9 %) of antisepsis sides versus 6 of 104 (5.8 %) of control sides (p = 0.45). Clinical infection occurred within 1 year in 9.7 % (6 of 62) of colonized sides (tubing or fluid) versus 1.5 % (2 of 136) of noncolonized sides (p = 0.03).
Conclusions
Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains, and reduced drain colonization was associated with fewer infections.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Reish RG, Damjanovic B, Austen WG, Jr, Winograd J, Liao EC, Cetrulo CL, et al. Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. Plast Reconstr Surg. 2013;131:1223–30.
Leyngold MM, Stutman RL, Khiabani KT, Shah H, Fong E, Ho CH, et al. Contributing variables to post mastectomy tissue expander infection. Br J. 2012;18:351–6.
Olsen MA, Lefta M, Dietz JR, Brandt KE, Aft R, Matthews R, et al. Risk factors for surgical site infection after major breast operation. J Am Coll Surg. 2008;207:326–35.
de Blacam C, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, et al. High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg. 2012;255:551–5.
Vilar-Compte D, Jacquemin B, Robles-Vidal C, Volkow P. Surgical site infections in breast surgery: case-control study. World J Surg. 2004;28:242–6.
Rey JE, Gardner SM, Cushing RD. Determinants of surgical site infection after breast biopsy. Am J Infect Control. 2005;33:126–9.
Rotstein C, Ferguson R, Cummings KM, Piedmonte MR, Lucey J, Banish A, et al. Determinants of clean surgical wound infections for breast procedures at an oncology center. Infect Control Hosp Epidemiol. 1992;13:207–14.
Degnim AC, Scow JS, Hoskin TL, Miller JP, Loprinzi M, Boughey JC, et al. Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations. Ann Surg. 2013;258:240–7.
Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296:1305–9.
Rosner B. Fundamentals of biostatistics. 4th ed. Belmont: Wadsworth Publishing Company, 1995.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomet Inform. 2009;42:377–81.
Felippe WA, Werneck GL, Santoro-Lopes G. Surgical site infection among women discharged with a drain in situ after breast cancer surgery. World J Surg. 2007;31:2293–9; discussion 2300–1.
Olsen MA, Chu-Ongsakul S, Brandt KE, Dietz JR, Mayfield J, Fraser VJ. Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg. 2008;143:53–60; discussion 61.
Garwood ER, Moore D, Ewing C, Hwang ES, Alvarado M, Foster RD, et al. Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients. Ann Surg. 2009;249:26–32.
Peled AW, Foster RD, Garwood ER, Moore DH, Ewing CA, Alvarado M, et al. The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study. Plast Reconstr Surg. 2012;129:901e–8e.
Timsit JF, Schwebel C, Bouadma L, Geffroy A, Garrouste-Orgeas M, Pease S, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA. 2009;301:1231–41.
Levy I, Katz J, Solter E, Samra Z, Vidne B, Birk E, et al. Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatr Infect Dis J. 2005;24:676–9.
Brahmbhatt RD, Huebner M, Scow JS, Harmsen WS, Boughey JC, Harris AM, et al. National practice patterns in preoperative and postoperative antibiotic prophylaxis in breast procedures requiring drains: survey of the american society of breast surgeons. Ann Surg Oncol. 2012;19:3205–11.
Phillips BT, Wang ED, Mirrer J, Lanier ST, Khan SU, Dagum AB, et al. Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care. Ann Plast Surg. 2011; 66:460–5.
Landes G, Harris PG, Lemaine V, Perreault I, Sampalis JS, Brutus JP, et al. Prevention of surgical site infection and appropriateness of antibiotic prescribing habits in plastic surgery. J Plast Reconstr Aesthet Surg. 2008;61:1347–56.
Throckmorton AD, Hoskin T, Boostrom SY, Boughey JC, Holifield AC, Stobbs MM, et al. Complications associated with postoperative antibiotic prophylaxis after breast surgery. Am J Surg. 2009;198:553–6.
Acknowledgment
Funds for this study were provided by Ethicon, Inc. This project was also supported by NIH Center for Translational Science Activities grant support (UL1 TR000135). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Sincere thanks to Jill Randolph R.Ph. and Sue McCluskey R.Ph. for preparation of dilute Dakin’s solution, Lisa M. Nyre, Sherry M. Ihde, and David T. Lynch in Microbiology, and to Marilyn Churchward for assistance with manuscript preparation. Most importantly, this study was made possible by the individuals who elected to participate in this research study.
Author information
Authors and Affiliations
Corresponding author
Additional information
ClinicalTrials.gov Identifier: NCT 01286168
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Degnim, A.C., Hoskin, T.L., Brahmbhatt, R.D. et al. Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction. Ann Surg Oncol 21, 3240–3248 (2014). https://doi.org/10.1245/s10434-014-3918-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-014-3918-9