The main causative agents of infectious complications during reconstructive surgery using allomaterials in patients with breast cancer

Abstract

Introduction: Surgical site infections (SSI) are one of the key problems in surgical practice. Despite the achievements of modern medicine, ongoing preventive measures, the incidence of wound infection remains quite high. This is especially relevant for oncoplastic surgery, since in most cases the installation of foreign materials (expanders, implants, meshes) is required to achieve a satisfactory cosmetic result.The purpose of the study: to identify the most common cause of infectious complications after reconstructive operations on the mammary gland using endoprostheses.Materials and methods: In a retrospective review of 526 consecutive implant-based breast reconstructions at a single institution from June 2020 to June 2022 was conducted. The frequency of development of infectious complications was assessed, as well as the taxonomic structure of the main pathogens that were isolated in the department of oncomammology in 2020–2022.Results: The incidence of infectious complications that led to the loss of the endoprosthesis during reconstructive surgery on the mammary gland was 6.7 %. The main causative agents of SSI leading to the loss of implants and the need for reoperations were Corynebacterium striatum (35.2 %) and Staphylococcus aureus (27.2 %). The spectrum of the most common pathogens that led to the loss of implants corresponded to the flora most often detected during bacterial culture in the department. The probability of implant loss was higher in the group of patients who underwent chemotherapy (14 of 197, 7.1 %) or chemoradiotherapy (14 of 188, 7.4 %) compared with patients who did not receive specific anticancer treatment (7 of 141, 4.9 %). However, taking patients who did not receive drug or radiation treatment as a reference group, statistical significance could not be achieved (p = 0.56 in the chemotherapy group and p = 0.49 in the chemoradiotherapy group).Conclusions: Our own experience has shown that, despite the current preventive measures, the frequency of infectious complications remains quite high. In the etiological structure of SSI pathogens, microorganisms of the genera Staphylococcus and Corynebacterium predominate. The use of broad-spectrum antibiotics in perioperative prophylaxis did not guarantee the absence of SSI in the postoperative period. An analysis of the sensitivity of isolated pathogens to antibacterial drugs, an assessment of the effectiveness of various antibiotic regimens in the future may allow us to develop an optimal antibiotic prophylaxis scheme for infectious complications during breast reconstructive surgery, therefore, further prospective studies in this direction are needed.