[Adequate Antibiotic Prophylaxis and Therapy of Periprosthetic Infections of the Breast - Review of 468 Consecutive Implant Removals].

Periprosthetic infections are feared complications in aesthetic as well as in reconstructive breast surgery. The purpose of our study was to evaluate our institution's specific culture data and to identify most common organisms and suitable antibiotics for prophylaxis and first line treatment in implant-based breast surgery. We analyzed all patients with a change or removal of breast implants in the period from 01.01.2012 to 31.12.2015 retrospectively. Based on the medical records, the surgical indications were identified and specifically analyzed for signs of infection and capsular fibrosis. In addition, we assessed all microbiological data of these interventions. 468 implant removals or exchanges were performed in 360 patients. Microbiological smears were gathered from 169 patients (249 implants). Bacteria were cultured from 23 implants (21 patients). In 6 additional implants (four patients) a periprosthetic infection was present, without pathogen detection. In most cases, advanced capsular fibrosis was the reason for implant exchange. In 17 smears bacterial detection was carried out despite absence of clinical signs of infection. In 17 cases coagulase-negative staphylococci were detected. In 4 Staphylococcus aureus, and once each E. coli, Morganella morganii and Proprionibacterium acnes (one double infection). All pathogens were sensitive to piperacillin/tazobactam and vancomycin. One resistancy was seen to cefuroxime and amoxicillin/clavulanic acid, and 2 to gentamicin, ciprofloxacin and clindamycin. In the majority of cases, pathogen detection was an incidental finding, while capsular contracture caused surgical revision. Pathogens and resistance patterns found in this study differed from the majority of international publications. In our institution, Cefuroxime and amoxicillin/clavulanic acid have been proven to be a reasonable choice for prevention and treatment of periprosthetic infections. Especially in fulminant infections piperacillin/tazobactam would be our choice for initial treatment, until the specific antibiogram is available.