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Surgical Site Infections in Breast Surgery: Case-control Study

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Abstract

The purpose of this study was to estimate the frequency of surgical site infections (SSIs) and identify associated risk factors for each type of breast surgery at a cancer hospital. We used a nested case-control design. Between February 1, 2000 and July 31, 2000, all breast surgeries performed were recorded on a daily basis. After hospital discharge, we evaluated patients simultaneously with surgeons three times a week for 30 days or longer. The odds ratio (OR) was estimated using logistic regression analysis. The study followed 280 patients (298 wounds). Altogether, 77 SSIs were detected, for an overall SSI rate of 25.8% (77/298). For excisions, conservative surgery, and radical mastectomies the SSI rates were 1.4%, 18.0%, and 38.3%, respectively. Excisions were excluded (n = 68) for risk factor analysis. After multivariate analysis, risk factors associated with SSIs were obesity [OR 2.5, 95% confidence interval (CI) 1.2–4.3], concomitant chemotherapy and radiation (OR 2.3, 95% CI 1.2–4.3), radical surgery (OR 3.1, 95% CI 1.1–8.6), insertion of a second drain during the late postoperative period (OR 3.7, 95% CI 1.8–7.8), and drainage duration ≥ 19 days (OR 2.9, 95% CI 1.5–5.6). The bacteria most frequently isolated were Pseudomonas aeruginosa (n = 18), Serratia sp. (n = 18), Staphylococcus aureus (n = 10), and Staphylococcus epidermidis (n = 10). Poor compliance with infection control practices and wound management was detected throughout the study period. The overall frequency of SSIs for mastectomies was higher than the reported rates, which was principally related to the more radical surgery required for advanced-stage disease, preoperative irradiation, and inadequate wound and drain care.

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References

  1. WT Hughes PM Flynn BG Williams (1999) Nosocomial infections in patients with neoplastic diseases CG Mayhall (Eds) Hospital Epidemiology and Infection Control EditionNumber2nd edition Lippincott Williams & Wilkins Philadelphia 767–771

    Google Scholar 

  2. GR Barber J Miransky AE Brown et al. (1995) ArticleTitleDirect observations of surgical wound infections at a comprehensive cancer center Arch. Surg. 130 1042–1047 Occurrence Handle1:STN:280:BymD2crlsFI%3D Occurrence Handle7575114

    CAS  PubMed  Google Scholar 

  3. C Rotstein R Ferguson M Cummings et al. (1992) ArticleTitleDeterminants of clean surgical wound infections for breast procedures at an oncology center Infect. Control Hosp. Epidemiol. 13 207–214 Occurrence Handle1:STN:280:By2B2snnsVI%3D Occurrence Handle1593101

    CAS  PubMed  Google Scholar 

  4. D Vilar-Compte A Mohar S Sandoval et al. (2000) ArticleTitleSurgical site infections at the National Cancer Institute in México: a case-control study Am. J. Infect. Control 28 14–20 Occurrence Handle10.1016/S0196-6553(00)90006-3 Occurrence Handle1:STN:280:DC%2BD3c7ktlCjug%3D%3D Occurrence Handle10679132

    Article  CAS  PubMed  Google Scholar 

  5. JR Broadwater MJ Edwards C Kuglen et al. (1991) ArticleTitleMastectomy following preoperative chemotherapy: strict operative criteria control operative morbidity Ann. Surg. 213 126–129 Occurrence Handle1:STN:280:By6C38fgt1U%3D Occurrence Handle1992938

    CAS  PubMed  Google Scholar 

  6. WE Burak PS Goodman DC Youn et al. (1997) ArticleTitleSeroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin J. Surg. Oncol. 64 27–31 Occurrence Handle10.1002/(SICI)1096-9098(199701)64:1<27::AID-JSO6>3.3.CO;2-9 Occurrence Handle9040797

    Article  PubMed  Google Scholar 

  7. TC Horan RP Gaynes WJ Martone et al. (1992) ArticleTitleCDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections Infect. Control Hosp. Epidemiol. 13 606–608 Occurrence Handle1:STN:280:ByyC3cjmsVQ%3D Occurrence Handle1334988

    CAS  PubMed  Google Scholar 

  8. WO Obrien PO Hasselgren RP Hummel et al. (1993) ArticleTitleComparision of postoperative wound complications and early cancer recurrence between patients undergoing mastectomy with or without immediate breast reconstruction Am. J. Surg. 166 1–5 Occurrence Handle1:STN:280:ByyA3Mbgtl0%3D Occurrence Handle8392300

    CAS  PubMed  Google Scholar 

  9. GS Terrell JA Singer (1991) ArticleTitleAxillary versus combined axillary and pectoral drainage after modified radical mastectomy Surg. Gynecol. Obstet. 175 437–440

    Google Scholar 

  10. Canavase G, Catturich A, Vecchio C, et al. (1997) Surgical complications related to peri-operative adjuvant chemotherapy in breast cancer: results of a prospective, controlled randomized clinical trial. 23:10–12

  11. PC Furey DC MacGillivary CL Castiglione et al. (1994) ArticleTitleWound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer J. Surg. Oncol. 55 194–197 Occurrence Handle1:STN:280:ByuB3s7nvVQ%3D Occurrence Handle8176932

    CAS  PubMed  Google Scholar 

  12. D Lefebvre N Penel MF Deberles et al. (2000) ArticleTitleIncidence et facteurs de risqué d’infections du site opératoire en chirurgie carcinologique mammaire Presse Med. 29 1927–1932 Occurrence Handle1:STN:280:DC%2BD3M7lt1Ghtg%3D%3D Occurrence Handle11244620

    CAS  PubMed  Google Scholar 

  13. ER Sauter BL Eisenberg JP Hoffman et al. (1993) ArticleTitle Postmastectomy morbidity after combination preoperative irradiation and chemotherapy for locally advanced breast cancer World J. Surg. 17 237–242 Occurrence Handle1:STN:280:ByyB1cbns1I%3D Occurrence Handle8511920

    CAS  PubMed  Google Scholar 

  14. AB Din ParticleEl C Guenier JM Nogaret et al. (1989) ArticleTitle Local postoperative morbidity following pre-operative irradiation in locally advanced breast cancer Eur. J. Surg. Oncol. 15 486–489 Occurrence Handle1:STN:280:By%2BD1M3lvVI%3D Occurrence Handle2599118

    CAS  PubMed  Google Scholar 

  15. SJ Mathes J Alexander (1996) ArticleTitleRadiation injury Surg. Oncol. Clin. N. Am. 5 809–824 Occurrence Handle1:STN:280:ByiD2MrmsF0%3D Occurrence Handle8899946

    CAS  PubMed  Google Scholar 

  16. J Miransky L Ruo S Nicoletta et al. (2001) ArticleTitleImpact of surgeon-trained observer on accuracy of colorectal surgical site infection rates Dis. Colon Rectum 44 1100–1105 Occurrence Handle1:STN:280:DC%2BD3MvptFOjtw%3D%3D Occurrence Handle11535848

    CAS  PubMed  Google Scholar 

  17. LA Israelsson T Jonson (1997) ArticleTitleOverweight and healing of the midline incisions: the importance of suture technique Eur. J. Surg. 163 175–180 Occurrence Handle1:STN:280:ByiB3sbjvFI%3D Occurrence Handle9085058

    CAS  PubMed  Google Scholar 

  18. RA Forse B Karam LD MacLean et al. (1989) ArticleTitleAntibiotic prophylaxis for surgery in morbidly obese patients Surgery 106 750–756 Occurrence Handle1:STN:280:By%2BD3MbpslA%3D Occurrence Handle2799651

    CAS  PubMed  Google Scholar 

  19. B Fisher J-H Jeong S Anderson et al. (2002) ArticleTitleFisher ER, Wolmark . Twenty-five year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation N. Engl. J. Med. 347 567–575 Occurrence Handle10.1056/NEJMoa020128 Occurrence Handle12192016

    Article  PubMed  Google Scholar 

  20. U Veronesi A Banfi B Salvadori et al. (1990) ArticleTitleBreast conservation is the treatment of choice in small breast cancer: long term results of a randomized clinical trial Eur. J. Cancer 26 668–670 Occurrence Handle1:STN:280:By%2BA28ngvFM%3D Occurrence Handle2144152

    CAS  PubMed  Google Scholar 

  21. CD Liu DW McFadden (1997) ArticleTitleOvernight closed suction drainage after axillary lymphadenectomy for breast cancer Am. Surg. 63 868–870 Occurrence Handle1:STN:280:ByiH28zpsF0%3D Occurrence Handle9322660

    CAS  PubMed  Google Scholar 

  22. RG Somers LK Jablon MJ Kaplan et al. (1992) ArticleTitleThe use of closed suction drainage after lumpectomy and axillary node dissection for breast cancer: a prospective randomized trial Ann. Surg. 215 146–149 Occurrence Handle1:STN:280:By2C1cbjslY%3D Occurrence Handle1546900

    CAS  PubMed  Google Scholar 

  23. R Gupta K Patel S Varshney et al. (2001) ArticleTitleA comparison of 5-day and 8-day drainage following mastectomy and axillary clearance Eur. J. Surg. Oncol. 27 26–30 Occurrence Handle10.1053/ejso.2000.1054 Occurrence Handle1:STN:280:DC%2BD3M7osFWlsA%3D%3D Occurrence Handle11237488

    Article  CAS  PubMed  Google Scholar 

  24. Vliar-Compte, D, Jacquemin, B, Diaz-Gonzalez, A, Velasquez, C, Volkow, P (2003) Brote por P. aeruginosa en el area de atención ambulatonia de heridou en pacientes posmastectomizadas. Salud Publica Mex 45: 371–378

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Infectious Diseases, Instituto Nacional de Cancerología, Avenida San Fernando 22, Col. Sección 16, Tlalpan, 14080, México, DF, México

    Diana Vilar-Compte M.D., Ms.C., Benedicte Jacquemin M.D. & Patricia Volkow M.D.

  2. Breast Tumor Department, Instituto Nacional de Cancerología, Avenida San Fernando 22, Col. Sección 16, Tlalpan, 14080, México, DF, México

    Carlos Robles-Vidal M.D.

Authors
  1. Diana Vilar-Compte M.D., Ms.C.
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  2. Benedicte Jacquemin M.D.
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  3. Carlos Robles-Vidal M.D.
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  4. Patricia Volkow M.D.
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Correspondence to Diana Vilar-Compte M.D., Ms.C..

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Vilar-Compte, D., Jacquemin, B., Robles-Vidal, C. et al. Surgical Site Infections in Breast Surgery: Case-control Study . World J. Surg. 28, 242–246 (2004). https://doi.org/10.1007/s00268-003-7193-3

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