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World J Surg (2013) 37:5966 DOI 10.1007/s00268-012-1816-5
A Randomized, Double-blinded Placebo-controlled Clinical Trial of the Routine Use of Preoperative Antibiotic Prophylaxisin Modied Radical Mastectomy
Nelson D. Cabaluna Gemma B. Uy
Rommel M. Galicia Shalimar C. Cortez
Marc Denver S. Yray Brian S. Buckley
Published online: 2 October 2012 Socit Internationale de Chirurgie 2012
AbstractBackground The effectiveness of antibiotic prophylaxis for prevention of surgical site infection (SSI) following specic types of breast cancer surgery remains uncertain. This study assessed the effectiveness of prophylaxis in modied radical mastectomy (MRM).
Methods Women undergoing MRM for breast cancer were recruited. Women were excluded who had diabetes mellitus, severe malnutrition or known allergy to cephalosporins; were receiving corticosteroid therapy or were treated with antibiotics within one week prior to surgery; were scheduled for simultaneous breast reconstruction or bilateral oophorectomy; had existing local infection. Participants were randomized to receive either intravenous cefazolin 1 g or placebo within 30 min prior to skin incision. Standard skin preparation and operative technique for MRM were carried out. Wounds were assessed for SSI and other complications weekly for 30 days.
Results A total of 254 women were recruited. Age, clinical stage, prior chemotherapy, and operative time were similar for antibiotic and placebo groups. The overall incidence of SSI was 14.2 %. There were no signicant differences in the infection rate over the 30-day follow-up period between the placebo and antibiotic groups (15 % vs13.4 %; p = 0.719) or at each week. The majority of SSI were either cellulitis or supercial infection for both groups. There were no signicant differences between
groups in treatments required for SSI, incidence of hematoma or seroma.
Conclusions The ndings of this study, alone and when meta-analyzed with data from studies in similar surgical populations, do not support the use of antibiotic prophylaxis in MRM.
Introduction
Surgical site infections (SSI) have been shown to be the second most common adverse event in hospitalized patients [1]. Any surgical procedure carries the risk of SSI and although seldom fatal, SSI can cause signicant morbidity and can delay subsequent adjuvant treatment [2]. Postoperative infection rates after surgery for breast cancer have been estimated to range from 3 to 15 % percent, higher than the usual rates for clean surgical procedures [3]. Surgery remains...