Antibiotic use in aesthetic surgery: a national survey and literature review

The Impact of a Multidisciplinary Approach Protocol and Integrated Guidelines for Antibiotic Prophylaxis in Plastic Surgery Procedures

BACKGROUND

Surgical antibiotic prophylaxis has been widely used for prevention of surgical site infections (SSI's). World Health Organization (WHO) global guidelines strongly recommend the administration of pre-operative prophylactic antibiotic, depending on the type of surgery, to reduce SSI's. However, within Gulf Cooperation Council (GCC) countries, antibiotic resistance has been rising due to unregulated prescribing practice. We aimed to assess adherence to local/international guidelines in the plastic surgery unit of Salmaniya Medical Complex.

METHODS

This study was a retrospective review of adults' undergoing plastic surgery between the dates of 1^st of January 2019 to 30^th of April 2019. Recommendations and guidelines were provided by South Australian Guidelines for Surgical Antimicrobial Prophylaxis, NHS Greater-Glasgow Foundation Trust. Salmaniya Medical Complex Guidelines were also taken into consideration. This was followed by an implementation of standardized guidelines and a re-assessment period for another four months.

RESULTS

There were 106 patients who met the inclusion/exclusion criteria throughout the primary cohort. With respect to choice and dose of antibiotics, only 21 (19.8%) of the procedures were adherent to global/local guidelines. Similarly, only 11.5% of those cases have met the recommended timing for pre-operative antibiotic administration. After the implementation period, adherence to guidelines regarding choice and time of antibiotic administration has increased to 36.8% and 32.6% respectively. SSI decreased from 1.8% to 0.08%.

CONCLUSION

Practice in SMC in plastic surgery pre-operative antibiotic prophylaxis shows poor compliance to both local and international guidelines in terms of choice, dose, and time of administration. We were able to significantly improve adherence to international/local practice in both areas by implementing an integrated protocol in liaison with the medical staff involved in the plastic surgery unit and operating theatres.

How to Prevent and Treat Complications in Facelift Surgery, Part 1: Short-Term Complications

This article provides a review of available evidence with regard to short-term complications in facelift surgery. The article reviews both the most common complications and less common, but well-described ones. The goal is to offer objective means to minimize postoperative complications and a guide for treatment when they occur.

Evaluation of Antibiotic Prophylaxis in Rhinoplasty: A Systematic Review and Meta-analysis

Importance

Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed.

Objective

To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis.

Data Sources

MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent.

Study Selection

Randomized clinical trials (RCTs) with adults (≥18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1.

Data Extraction and Synthesis

Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model.

Main Outcomes and Measures

Difference in infectious complication rate between groups.

Results

A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86).

Conclusions and Relevance

This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study's results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty.

Level of Evidence

1.

The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?-A Review

Background:

With antimicrobial resistance a global threat, optimizing antibiotic usage across the surgical continuum is vital. The American Academy of Otolaryngology—Head and Neck Surgery Foundation recently published the first guidelines addressing management in rhinoplasty. The authors reviewed pertinent literature on the role of systemic antibiotics in rhinoplasty and septorhinoplasty.

Methods:

The authors performed a MEDLINE search through PubMed using the key terms rhinoplasty, septorhinoplasty, infection, antimicrobials, and antibiotics.

Results:

Ten studies met criteria. Studies evaluating antibiotics perioperatively showed similar infection and/or bacteremia rates (0–13.3%) in those receiving or not receiving antibiotics. No patients experienced significant local/systemic infections regardless of antibiotic use. In the 3 studies evaluating antibiotics postoperatively, antibiotics decreased the infection rate from 27% to 8% in complex revision cases. In a study evaluating postoperative antibiotics in noncomplex cases, there were no significant differences in infection rates between those receiving only a preoperative dose and those receiving preoperative in addition to 7 days of postoperative antibiotics, with the latter experiencing higher rates of antibiotic-related adverse events and costs.

Conclusions:

Peri- and postoperative antibiotics in noncomplex rhinoplasty and septorhinoplasty are not beneficial in decreasing infection risk. Antibiotics, with a first-generation cephalosporin such as cefazolin (non–β-lactam, such as clindamycin, if β-lactam allergy), should be considered in patients with comorbidities/undergoing complex surgery. If perioperative antibiotics are used, antibiotics should be administered within 1 hour of incision and discontinued within 24 hours of the operation. Further research is warranted to evaluate the optimal duration of postoperative antibiotics in complex cases.

Prevalence and Predictors of Postdischarge Antibiotic Use Following Mastectomy

OBJECTIVE Survey results suggest that prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction. DESIGN Retrospective cohort. PATIENTS Commercially insured women aged 18-64 years coded for mastectomy from January 2004 to December 2011 were included in the study. Women with a preexisting wound complication or septicemia were excluded. METHODS Predictors of prophylactic antibiotics within 5 days after discharge were identified in women with 1 year of prior insurance enrollment; relative risks (RR) were calculated using generalized estimating equations. RESULTS Overall, 12,501 mastectomy procedures were identified; immediate reconstruction was performed in 7,912 of these procedures (63.3%). Postdischarge prophylactic antibiotics were used in 4,439 procedures (56.1%) with immediate reconstruction and 1,053 procedures (22.9%) without immediate reconstruction (P.05). CONCLUSIONS Prophylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. Stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance. Infect Control Hosp Epidemiol 2017;38:1048-1054.

Antibiotic prophylaxis in reduction mammaplasty: study protocol for a randomized controlled trial

Background

The role of antibiotics in surgical procedures where the risk of surgical site infection (SSI) is low remains uncertain. There is, to date, no evidence to justify the routine use of antibiotics in postoperative reduction mammaplasty. The aim of this study is to evaluate the effect of postoperative antibiotic treatment on the occurrence of SSI after breast reduction surgery.

Methods

This is a double-blind randomized clinical trial with 124 breast hypertrophy patients allocated to two treatment groups: antibiotic (n = 62) and placebo (n = 62). All patients will undergo reduction mammoplasty, performed by the same surgical team. The surgeons will raise the nipple-areola complex by the superomedial pedicle technique. The patients will receive antibiotics intravenously during anesthetic induction and every 6 hours thereafter during their 24-hour hospital stay. During discharge from the hospital, each patient will receive a numbered package containing either cephalexin or placebo capsules and will be directed to take one capsule every 6 hours for 7 days. Neither the surgery team nor the patients will know the contents of the capsules. Patients will be monitored for the occurrence of SSI once weekly during the first 30 days following hospital discharge by a single surgeon who is blinded to their treatment group. SSI will be evaluated based on the definition adopted by the Centers for Disease Control and Prevention.

Discussion

Due to the variety of risk factors for SSI and limited case studies, conclusions regarding the effect of antibiotics on the occurrence of SSIs following reduction mammaplasty are potentially biased. In recent studies, perioperative antibiotic prophylaxis was effective in preventing infection and is therefore recommended in clinical practice. However, antibiotic use in the postoperative period still remains controversial.

Trial registration

Clinicaltrials.gov Identifier: NCT02569866. Registered on 4 October 2015.

Autologous Fat Augmentation and Periorbital Laser Resurfacing Complicated by Abscess Formation

Introduction:

There are many modalities for rejuvenation of the aging face, including rhytidectomy, soft tissue augmentation, and skin resurfacing. Skin resurfacing modalities for the treatment of rhytides include chemical peels, dermabrasion, and laser resurfacing. Complications of skin resurfacing include infection, prolonged erythema, and scar formation. Autologous fat augmentation used for soft tissue “rejuvenation” of the face has the advantages of having no allergic reactions or rejection. Complications include edema, ecchymoses, pain, nerve or blood vessel damage, infections, and rarely orbital or cerebral emboli. The author presents a case of an abscess formation of the lacrimal duct system in a patient with autologous fat augmentation and laser resurfacing preceded by tear-duct punctal plugs 1 week prior to surgery.

Materials and Methods:

An overall healthy 55-year-old female was seeking treatment of periorbital rhytides and mild dermatochalasis, prominent nasojugal creases, malar fat pad ptosis, prominent melolabial folds, and mild jowling. She underwent periorbital laser resurfacing, autologous fat augmentation (malar eminence, infraorbital region, melolabial folds), and liposuction of the jowls. One week prior to her surgery the patient had punctal tear duct plugs placed for the treatment of epiphora.

Results:

The patient developed unilateral facial pain and edema with subsequent abscess formation along the right infraorbital region. A CT-scan was obtained which showed soft tissue swelling without the presence of a retro-orbital cellulitis. The abscess was drained and antibiotic treatment administered. A diagnosis of dacryocystitis was made and upon dacryocystorhinostomy, a large dacryolith was discovered.

Discussion:

Although surgeons are aware of the complications associated with the procedures they perform, it is extremely important to keep in mind other surgeries that patients may have had elsewhere and the complications associated with them.

Understanding the Etiology and Prevention of Capsular Contracture: Translating Science into Practice

Capsular contracture remains a common and preventable complication of implanted breast prostheses. As our understanding of the pathophysiology continues to develop, it is prudent to reexamine existing beliefs in a contemporary context. This article presents a current summary of clinical and laboratory evidence, expressed as an interaction between potentiating and suppressing factors, and how this understanding can be applied to practice.

Application time for postoperative wound dressing following breast augmentation with implants: study protocol for a randomized controlled trial

Background

Breast augmentation with silicone implants is one of the most frequently performed cosmetic surgeries worldwide. Surgical site infection (SSI) remains an important complication of this procedure. One of the most important risk factors for SSI is the presence of microorganisms on the skin surrounding the wound. Guidelines by the Centers for Disease Control (CDC) recommend that surgical wounds be covered with a sterile dressing for 24 to 48 hours. However, a recent study showed that the application of a dressing for six days after breast reduction reduced wound colonization by coagulase-negative staphylococci.

Methods/Design

A randomized clinical trial was designed to assess two protocols of postoperative wound care to determine how the application duration of the postoperative dressing influences wound colonization in patients undergoing breast augmentation with silicone implants. Women aged between 18 and 60 years who are candidates for breast augmentation with silicone implants will be randomly allocated to group I (n = 48), in which the dressing will be removed on the first postoperative day, or group II (n = 48), in which the dressing will be removed on the sixth postoperative day. Cutaneous colonization will be assessed by cultures of samples of skin flora taken from the wound region. The incidence of SSI, using standardized CDC criteria, and the perceptions of patients towards the dressing will be secondary outcomes.

Discussion

An important component of SSI prevention is to minimize all possible risk factors, and the application of postoperative dressing plays a key role in this endeavor. The results of this clinical trial may help to standardize postoperative wound care after breast augmentation with silicone implants.

Trial registration

This trial was registered on 12 March 2012 with ClinicalTrials.gov (identifier: NCT01553604).

Guideline for Antimicrobial Prophylaxis in Breast Surgery

The American Society of Health-System Pharmacists (ASHP) published the 2012/2013 edition of the book entitled "Best Practices for Hospital & Health-System Pharmacy: Position and Guidance Documents of ASHP" with Bruce Hawkins as the editor. (ISSN: 15558975). Pages 582-667 of this book contain the section: "Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery". This section includes current clinical developments, evidence and recommendations on the application of standard and effective antimicrobial prophylaxis in adult and pediatric patients, and has significant differences compared to the previous 1999 edition. On pages 632-633, antimicrobial prophylaxis in breast and plastic surgery practice is addressed in detail. This article contains a summary of the recommendations made in ASHP 2012/2013 Report regarding the antimicrobial prophylaxis in breast and plastic surgery applications.

An unpredicted side effect of prophylactic antibiotic use

INTRODUCTION AND OBJECTIVE

We investigated the effects of cefazolin sodium (CS), on wound healing in rats.

MATERIAL AND METHOD

Forty rats in which an incisional wound model was created by removing two skin strips (4×1 cm), and suturing the wound edges, were included. Four groups were formed in a randomized way with each having 10 rats. The Control group (Group 1) received 1 cc 0·9% NaCl twice daily, whereas Group 2 received single-dose preoperative 30 mg/kg CS, Group 3 received single-dose preoperative 30 mg/kg CS followed by the same dose for three postoperative days, and Group 4 received single-dose preoperative 30 mg/kg CS followed by the same dose for seven postoperative days (via i.p. route). On the first day of the study, as the wound was created, a skin strip of 1×1 cm area was collected for bacteriologic examination. On the third day, specimens were acquired from the incision for histopathologic examination. The rats were sacrificed on the seventh day and more specimens were gained for histopathologic, tensiometric, and bacteriologic tests.

RESULT

Group 4 demonstrated disrupted normal skin flora; reduced inflammatory cell density, fibroblastic activity, and collagen density; and decreased wound tensile strength. The histopathologic findings with Groups 2 and 3 were as same as with Group 4 and wound tensile strength showed no significant difference compared with the Control group. Group 2 revealed no significant difference compared with the Control group with regard to all parameters.

DISCUSSION

Seven-day CS therapy had a negative effect on wound healing and changed the normal skin flora.

Dressing wear time after breast reconstruction: study protocol for a randomized controlled trial

BACKGROUND

One of the major risk variables for surgical site infection is wound management. Understanding infection risk factors for breast operations is essential in order to develop infection-prevention strategies and improve surgical outcomes. The aim of this trial is to assess the influence of dressing wear time on surgical site infection rates and skin colonization. Patients' perception at self-assessment will also be analyzed.

METHODS/DESIGN

This is a two-arm randomized controlled trial. Two hundred breast cancer patients undergoing immediate or delayed breast reconstruction will be prospectively enrolled. Patients will be randomly allocated to group I (dressing removed on postoperative day one) or group II (dressing removed on postoperative day six). Surgical site infections will be defined by standard criteria from the Centers for Disease Control and Prevention (CDC). Skin colonization will be assessed by culture of samples collected at predefined time points. Patients will score dressing wear time with regard to safety, comfort and convenience.

DISCUSSION

The evidence to support dressing standards for breast surgery wounds is empiric and scarce. CDC recommends protecting, with a sterile dressing for 24 to 48 hours postoperatively, a primarily closed incision, but there is no recommendation to cover this kind of incision beyond 48 hours, or on the appropriate time to shower or bathe with an uncovered incision. The results of the ongoing trial may support standard recommendations regarding dressing wear time after breast reconstruction.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: http://NCT01148823.

Once is not enough: withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of infection

BACKGROUND

There has been a trend toward limiting perioperative prophylactic antibiotics, based on research not conducted in plastic surgery patients. The authors' university hospital instituted antibiotic prescribing guidelines based on the Surgical Care Improvement Project. An increased rate of surgical-site infections was noted in breast reconstruction patients. The authors sought to determine whether the change in antibiotic prophylaxis regimen affected rates of surgical-site infections.

METHODS

A retrospective study compared patients undergoing breast reconstruction who received preoperative and postoperative prophylactic antibiotics with a group who received only a single dose of preoperative antibiotic. Type of reconstruction and known risk factors for implant infection were noted.

RESULTS

Two hundred fifty patients were included: 116 in the pre-Surgical Care Improvement Project group and 134 in the Surgical Care Improvement Project group. The overall rate of surgical-site infections increased from 18.1 percent to 34.3 percent (p = 0.004). Infections requiring reoperation increased from 4.3 percent to 16.4 percent (p = 0.002). Multivariate logistic regression demonstrated that patients in the Surgical Care Improvement group were 4.74 times more likely to develop a surgical-site infection requiring reoperation (95 percent CI, 1.69 to 13.80). Obesity, history of radiation therapy, and reconstruction with tissue expanders were associated with increased rates of surgical-site infection requiring reoperation.

CONCLUSIONS

Withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of surgical-site infection, reoperation, and thus reconstructive failure. The optimal duration of postoperative prophylactic antibiotic use is the subject of future study.

Secondary augmentation mammaplasties and periprosthetic infection: a three-year retrospective review

BACKGROUND

Secondary or revision surgery following primary augmentation mammaplasty is common. There are several published studies on the incidence and prevention of infection after primary augmentation mammaplasty, but there is a paucity of information on the incidence of periprosthetic infection after secondary or revision augmentation mammaplasty procedures.

OBJECTIVES

The author evaluates the incidence of periprosthetic infection in a series of revision and secondary mammaplasty patients from his practice.

METHODS

A retrospective review was performed of the charts for 92 consecutive patients who underwent bilateral secondary mammaplasty with the author between July 2008 and April 2011. Each breast was taken as a single unit, for a total of 184 breasts. The data were compiled and compared with previous studies related to periprosthetic infection following primary augmentation mammaplasty.

RESULTS

The average age of the patients was 35.8±7.9 years (range, 19-54 years). One patient developed unilateral periprosthetic infection in her left breast. This incidence of 0.54% was comparable to infection incidence of 0.5% for primary augmentation mammaplasty previously reported by the author.

CONCLUSIONS

In this series, there was no higher incidence of infection seen in secondary augmentation mammaplasty than was seen in previous studies on primary mammaplasty.

LEVEL OF EVIDENCE

4.

Benefit of a single dose of preoperative antibiotic on surgical site infection in varicose vein surgery

BACKGROUND

Ligation and division of the saphenofemoral junction (L/D SFJ) can protect against the danger of venous thromboembolism (VTE) associated with greater saphenous vein (GSV) radiofrequency ablation (RFA). Although this procedure is regarded as clean from an infection standpoint, surgical site infection (SSI) can offset its thromboembolic benefit. We questioned whether SSI associated with L/D SFJ could be minimized by a single preoperative dose of antibiotic.

METHODS

A retrospective cohort study was performed on 902 ambulatory surgery patients who underwent 953 consecutive RFAs of the GSV in combination with L/D SFJ. A single dose of preoperative antibiotic was administered 1 hour before incision to some patients (n = 449 extremities), with all other patients receiving no antibiotic (n = 504). Primary outcome measure was SSI categorized based on type of therapy required (1: oral antibiotic, 2: hospitalization for intravenous antibiotic and/or wound debridement), with a secondary outcome measure of VTE.

RESULTS

VTE occurred in 10 patients (1%) and included three pulmonary emboli. The majority of VTE were calf deep vein thromboses (n = 7). SSI developed in 78 patients (8.2%) with groin, thigh, and calf distributions of 47%, 8%, and 45%, respectively. All category 2 infections (n = 8, 10%) occurred in control subjects, and the majority were located in the groin. Body mass index significantly increased risk for both overall (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.05-1.14, P < 0.0001) and groin (OR: 1.08, 95% CI: 1.02-1.14, P = 0.01) SSI as well as VTE (OR: 1.17, 95% CI: 1.08-1.30, P = 0.003). Diabetes was a significant risk for groin SSI (OR: 5.13, 95% CI: 1.44-18.26, P = 0.01). Antibiotic was associated with a significantly reduced risk for both overall (OR: 0.54, 95% CI: 0.37-0.89, P = 0.02) and groin (OR: 0.34, 95% CI: 0.16-0.73, P = 0.01) SSI. Furthermore, prophylaxis eliminated category 2 infections (P = 0.008) and was associated with a significantly lower risk of VTE (OR: 0.11, 95% CI: 0.01-0.85, P = 0.01). Although SSI was noted more commonly in extremities with thromboembolic complications (20% [n = 2] vs. 8.1% [n = 76] in those without), this trend was not significant and could not account for the antibiotic effect on VTE.

CONCLUSIONS

L/D SFJ combined with RFA of the GSV, when treated as a clean procedure and not prophylaxed with antibiotic, carries a significant risk of SSI. While diabetes and high body mass index are patient-associated SSI risk factors, a single dose of preoperative antibiotic significantly reduces the rate of all infection, eliminates the danger of serious infection, and is associated with minimal VTE.

Implant infection after augmentation mammaplasty: a review of the literature and report of a multidrug-resistant Candida albicans infection

BACKGROUND

Implant breast augmentation is one of the most frequently performed surgical procedures, and fungal infection still is considered exceptional. This report presents a case of bilateral breast implant infection by multidrug-resistant Candida albicans treated with a targeted antifungal therapy.

METHODS

A young woman presented with breast pain and asymmetry as well as implant superficialization in the left breast 3 years after bilateral tuberous breast correction with implant insertion. She did not report any trauma to the chest wall or recent systemic infections. The breast was evaluated through mammary compliance analysis and magnetic resonance imaging (MRI).

RESULTS

At surgery, both implants showed capsule contracture and were surrounded by a gelatinous yellow-brown and turbid fluid, which was sent for microbial and fungal analysis. A bilateral capsulectomy was performed. After copious irrigation of the subglandular pockets, submuscular pockets were created, and implants were substituted. Culture swabs tested positive for C. albicans and showed drug resistance to amphotericin B, fluconazole, itraconazole, and voriconazole on the fungal antibiogram. Targeted antifungal therapy with caspofungin was administrated in association with oral antibiotic therapy. Follow-up assessment at 1, 3, 6, 12, and 24 months did not show any infection or contracture relapse.

CONCLUSIONS

This is the first report in the literature on a breast implant infection by a multidrug-resistant C. albicans. The study focused on the association between fungal contamination and capsular contracture and investigated the importance of a fungal antibiogram in cases of suspected prosthesis infection for performance of a targeted antifungal treatment.

Evaluating the role of postoperative prophylactic antibiotics in primary and secondary breast augmentation: a retrospective review

BACKGROUND

The use of postoperative prophylactic antibiotics following augmentation mammaplasty remains a controversial topic, with many surgeons opting for extended prophylaxis.

OBJECTIVES

The authors evaluate the role of postoperative prophylactic antibiotics in both primary and secondary cosmetic breast augmentation.

METHODS

A five-year retrospective chart review was performed on all patients undergoing cosmetic breast augmentation at a single institution from January 2005 to December 2009. The four attending physicians in this study utilized similar perioperative protocol and implant materials. Patients were divided into two cohorts: those who had received three days of postoperative antibiotics (primarily cephalosporins) and those who had not. End points of particular interest included infection, capsular contracture (CC), and local wound complications. The mean follow-up time was 3.8 years.

RESULTS

A total of 605 implants were included over the five-year study period. The overall infection rate was 0.66%. For primary augmentation, 493 implants were studied, with 52% of those patients having received postoperative antibiotics. There was no statistically significant reduction in infection, CC, or total complication rate for those receiving postoperative antibiotics. Similarly, 112 implants were studied for secondary augmentation, and again, postoperative antibiotics were not associated with a reduction in complications.

CONCLUSIONS

The data suggest that there was no reduction in the overall rate of total complications, infection, or CC with postoperative prophylactic antibiotics for either primary or secondary cosmetic breast augmentation. This study provides Level 3 evidence in support of discontinuing prophylactic postoperative antibiotics following cosmetic breast augmentation.

Prophylactic antibiotics in aesthetic surgery

Improvements in infection prevention practices over the past several decades have enhanced outcomes following aesthetic surgery. However, surgical site infections (SSI) continue to result in increased morbidity, mortality, and cost of care. The true incidence rate of SSI in aesthetic surgery is unknown due to the lack of a national surveillance system, but studies of SSI across surgical specialties have suggested that many of these infections are preventable. Patient-related factors-including obesity, glycemic control, and tobacco use-may contribute to the development of SSI following aesthetic surgery. In terms of SSI prevention, proper handwashing and surgical skin preparation are integral. Furthermore, the administration of prophylactic antibiotics has been shown to reduce SSI following many types of surgical procedures. Unfortunately, there are few large, randomized studies examining the role of prophylactic antibiotics in aesthetic surgery. The authors review the medical literature, discuss the risks of antibiotic overutilization, and detail nonpharmacological methods for reducing the risk of SSI.

Randomized controlled trial of the effectiveness of chlorhexidine showers before elective plastic surgical procedures

This randomized controlled trial was designed to assess the effect of preoperative chlorhexidine showers on skin colonization and postoperative infection rates associated with plastic surgical procedures involving the trunk. Chlorhexidine showers were effective in reducing skin colonization with coagulase-negative staphylococci and yeasts, but there was no difference in postoperative infection rates.

Infection, host resistance, and antimicrobial management of the surgical patient

Chemotherapeutic management of the microbial milieu that impacts patients undergoing surgery is profoundly important in surgery involving the head and neck region. This region is a repository for a diverse population of microbes, which stand ready to invade the underlying structures once the barriers have been breached. This article evaluates human resistance to these microorganisms and reviews conditions that may increase susceptibility in patients undergoing surgery.

Antibiotic use in abdominoplasty: prospective analysis of 207 cases

The increasing demand for plastic surgery of the abdomen has also increased the number of complications, some of them very difficult to manage. It has been stated that antibiotics are unquestionably effective in preventing postoperative wound infections. In the present study, we aimed to provide guidelines for the use of prophylactic antibiotics in abdominoplasty operations. A prospective study was planned on 207 patients. Three study groups were formed according to the administration of antibiotics as follows: group 1, no antibiotics; group 2, preoperative antibiotics only; and group 3, both preoperative and postoperative antibiotics. Twenty patients showed bacterial growth in the intraoperative bacterial culture. There was significant difference in the incidence of infection between groups 1 and 2, groups 1 and 3, but there was no difference between groups 2 and 3. In conclusion, we recommend a single preoperative dose of intravenous antibiotic to prevent infection and also secure the patient from antibiotic side effects.

Perioperative Antibiotic Usage by Facial Plastic Surgeons

OBJECTIVES

To determine current practice for use of perioperative antibiotics among facial plastic surgeons, to determine the extent of use of literature support for preferences of facial plastic surgeons, and to compare patterns of use with nationally supported evidence-based guidelines.

METHODS

A link to a Web site containing a questionnaire on perioperative antibiotic use was e-mailed to more than 1000 facial plastic surgeons in the United States. Responses were archived in a dedicated database and analyzed to determine patterns of use and methods of documenting that use. Current literature was used to develop evidence-based recommendations for perioperative antibiotic use, emphasizing current nationally supported guidelines.

RESULTS

Preferences varied significantly for medication used, dosage and regimen, time of first dose relative to incision time, setting in which medication was administered, and procedures for which perioperative antibiotic was deemed necessary.

CONCLUSIONS

Surgical site infection in facial plastic surgery can be reduced by better conformance to currently available evidence-based guidelines. We offer specific recommendations that are supported by the current literature.

Rhinologic pharmacotherapy in rhinoplasty

Rhinoplasty surgeons inevitably encounter therapeutic considerations in managing their patients, and a thorough understanding of nasal function, as well as of disorders of the nose and sinuses, is requisite for positive clinical outcomes. Patients suffering from allergic rhinitis are not precluded from undergoing rhinoplasty, whereas other disease processes may warrant an otolaryngologic evaluation before proceeding with surgery. A thorough medical history and examination elucidate sinonasal disease conditions that may not improve after septorhinoplasty but potentially could respond to pharmacologic therapy.