• Nicolas Penel, Penel Nicolas, Yazdan Yazdanpanah, Yazdanpanah Yazdan, Marie-Pierre Chauvet, Chauvet Marie-Pierre, Stéphanie Clisant, Clisant Stéphanie, Sylvia Giard, Giard Sylvia, Jean-Charles Neu, Neu Jean-Charles, Danièle Lefebvre, Lefebvre Danièle, Charles Fournier, Fournier Charles, Jacques Bonneterre, and Bonneterre Jacques.
• Département de Cancérologie Générale, Centre Oscar Lambret, France. n-penel@o-lambret.fr
• J Surg Oncol. 2007 Aug 1; 96 (2): 124-9.

ObjectiveWe previously showed that previous chemotherapy and immediate breast reconstruction were associated with an increased risk of surgical site infection (SSI) in patients undergoing breast cancer surgery. The present before-after study evaluated a preventive strategy for high-risk patients.Patients And MethodsWe compared the incidence of SSI in two prospective observational cohorts of patients underwent clean procedure in curative intent for a-biopsy proven breast cancer: a historical cohort followed before implementation of a preventive strategy and a second cohort followed thereafter. The strategy consisted of identifying patients at risk of SSI and prophylaxis administration of cefuroxime to those patients. The impact of our strategy was analyzed using a logistic regression model adjusted for potential confounders.ResultsSSI incidence was estimated at 19/542 (3.5%) before preventive strategy versus 2/247 (0.8%) thereafter (crude odds ratio (OR) 0.22 confidence interval [95% CI 0.05-0.97], P = 0.03). After adjustment for confounders (breast reconstruction, previous breast surgery, and duration of surgery), our preventive strategy reduced the risk of SSI by 81% (adjusted OR 0.19 [95% CI 0.04-0.85], P = 0.03).ConclusionThese results showed that antibiotic prophylaxis is beneficial for patients at high-risk of WI after breast cancer surgery. Randomized controlled trials should now confirm these findings.

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