Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Plastic Surgery
Published in: European Journal of Plastic Surgery 5/2019

01-10-2019 | Abdominoplasty | Original Paper

Antibiotic prophylaxis: current recommendations in plastic surgery

Authors: Shana S. Kalaria, Thanapoom Boonipat, J. Michael Smith, Eric L. Cole

Published in: European Journal of Plastic Surgery | Issue 5/2019

Login to get access

Abstract

Background

Guidelines for prophylactic antibiotics in surgery have long been established; however, few have focused on recommendations in plastic surgery. Surgical site infection rates remain low, yet the use of prophylactic antibiotics has surged in the past 30 years. This article summarizes current recommendations of prophylactic antibiotic use to produce consensus guidelines in plastic surgery.

Methods

A literature review was conducted in the PubMed, Cochrane, and Ovid databases and studies were included if randomized controlled trials indicated a statistically significant decrease in surgical site infections. Surveys conducted by the American Society of Plastic Surgeons regarding prophylactic antibiotic use from 1975, 1985, 2000, and 2010 were compiled and analyzed.

Results

Of 143 articles found, nine randomized controlled trials showed a reduction in surgical site infections after antibiotic prophylaxis for specific plastic surgery procedures. There are evidence-based recommendations for prophylactic antibiotics in breast surgery, abdominoplasty, contaminated hand or face surgery, prosthetic surgery, rhinoplasty, microsurgery, and acute and burn reconstruction cases. The proportion of plastic surgeons using prophylactic antibiotics has steadily increased from 1975 to 2010 with a significant increase from 2000 to 2010.

Conclusions

Systemic antibiotic prophylaxis is recommended for use in breast surgery, abdominoplasty, contaminated hand or face surgery, prosthetic surgery, rhinoplasty, microsurgery, and acute and burn reconstruction cases. Recent surveys indicate that the majority of plastic surgeons continue to use prophylactic antibiotics in clean cases of the hand, face, and body despite recommendations. Additional procedure-specific randomized controlled trials are necessary to provide evidence-based recommendations for antibiotic prophylaxis in plastic surgery.
Level of Evidence: Level IV, risk / prognostic study
Literature
1.
No authors listed (2012) Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett 10:73–78 quiz 79–80
2.
Gravante G, Caruso R, Araco A, Cervelli V (2008) Infections after plastic procedures: incidences, etiologies, risk factors, and antibiotic prophylaxis. Aesthetic Plast Surg 32:243–251
3.
4.
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA, American Society of Health-System P, Infectious Diseases Society of A, Surgical Infection S, Society for Healthcare Epidemiology of A (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect 14:73–156CrossRef
5.
Parikh RP, Nguyen DC, Skolnick GB, Patel KB, Woo AS (2015) Surgical site infections in pediatric plastic surgery: risk factors and implications for quality improvement from a nationwide assessment of 11,656 operations. Plast Reconstr Surg 136:120CrossRef
6.
Porco TC, Gao D, Scott JC, Shim E, Enanoria WT, Galvani AP, Lietman TM (2012) When does overuse of antibiotics become a tragedy of the commons? PLoS One 7:e46505CrossRefPubMedPubMedCentral
7.
Hall AJ, Curns AT, McDonald LC, Parashar UD, Lopman BA (2012) The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007. Clin Infect Dis 55:216–223CrossRefPubMed
8.
Hansen D, Pollan LD, Fernando H (2013) Fulminant Clostridium difficile colitis: a complication of perioperative antibiotic prophylaxis. J Oral Maxillofac Surg 71:1880–1885CrossRefPubMed
9.
Landes G, Harris PG, Lemaine V, Perreault I, Sampalis JS, Brutus JP, Lessard L, Dionyssopoulos A, Nikolis A (2008) Prevention of surgical site infection and appropriateness of antibiotic prescribing habits in plastic surgery. J Plast Reconstr Aesthet Surg 61:1347–1356CrossRefPubMed
10.
Li GH, Hou DJ, Fu HD, Guo JY, Guo XB, Gong H (2014) A review of prophylactic antibiotics use in plastic surgery in China and a systematic review. Int J Surg 12:1300–1305CrossRefPubMed
11.
Garner JS (1986) CDC guideline for prevention of surgical wound infections, 1985. Supersedes guideline for prevention of surgical wound infections published in 1982. (Originally published in November 1985). Revised. Infect Control 7:193–200CrossRefPubMed
12.
Simmons BP (1982) Guideline for prevention of surgical wound infections. Infect Control 3:185–196
13.
Krizek TJ, Gottlieb LJ, Koss N, Robson MC (1985) The use of prophylactic antibacterials in plastic surgery: a 1980s update. Plast Reconstr Surg 76:953–963CrossRefPubMed
14.
Krizek TJ, Koss N, Robson MC (1975) The current use of prophylactic antibiotics in plastic and reconstructive surgery. Plast Reconstr Surg 55:21–32CrossRefPubMed
15.
Lyle WG, Outlaw K, Krizek TJ, Koss N, Payne WG, Robson MC (2003) Prophylactic antibiotics in plastic surgery: trends of use over 25 years of an evolving specialty. Aesthet Surg J 23:177–183CrossRefPubMed
16.
Elward AM, McAndrews JM, Young VL (2009) Methicillin-sensitive and methicillin-resistant Staphylococcus aureus: preventing surgical site infections following plastic surgery. Aesthet Surg J 29:232–244CrossRefPubMed
17.
Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, Fridkin SK, National Healthcare Safety Network T, Participating National Healthcare Safety Network F (2008) NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 29:996–1011CrossRefPubMed
18.
Yoo DB, Peng GL, Azizzadeh B, Nassif PS (2015) Microbiology and antibiotic prophylaxis in rhinoplasty: a review of 363 consecutive cases. JAMA Facial Plast Surg 17:23–27CrossRefPubMed
19.
Perrotti JA, Castor SA, Perez PC, Zins JE (2002) Antibiotic use in aesthetic surgery: a national survey and literature review. Plast Reconstr Surg 109:1685–1695CrossRefPubMed
20.
Ariyan S, Martin J, Lal A, Cheng D, Borah GL, Chung KC, Conly J, Havlik R, Lee WP, McGrath MH, Pribaz J, Young VL (2015) Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the American Association of Plastic Surgeons. Plast Reconstr Surg 135:1723–1739CrossRefPubMed
21.
Hardwicke JT, Bechar J, Skillman JM (2013) Are systemic antibiotics indicated in aesthetic breast surgery? A systematic review of the literature. Plast Reconstr Surg 131:1395–1403CrossRefPubMed
22.
Shortt R, Cooper MJ, Farrokhyar F, Bain J (2014) Meta-analysis of antibiotic prophylaxis in breast reduction surgery. Plast Surg (Oakv) 22:91–94CrossRef
23.
Amland PF, Andenaes K, Samdal F, Lingaas E, Sandsmark M, Abyholm F, Giercksky KE (1995) A prospective, double-blind, placebo-controlled trial of a single dose of azithromycin on postoperative wound infections in plastic surgery. Plast Reconstr Surg 96:1378–1383CrossRefPubMed
24.
Khan UD (2010) Breast augmentation, antibiotic prophylaxis, and infection: comparative analysis of 1,628 primary augmentation mammoplasties assessing the role and efficacy of antibiotics prophylaxis duration. Aesthetic Plast Surg 34:42–47
25.
Sevin A, Senen D, Sevin K, Erdogan B, Orhan E (2007) Antibiotic use in abdominoplasty: prospective analysis of 207 cases. J Plast Reconstr Aesthet Surg 60:379–382CrossRefPubMed
26.
Toia F, D’Arpa S, Massenti MF, Amodio E, Pirrello R, Moschella F (2012) Perioperative antibiotic prophylaxis in plastic surgery: a prospective study of 1,100 adult patients. J Plast Reconstr Aesthet Surg 65:601–609CrossRefPubMed
27.
Alexander JW, MacMillan BG, Law EJ, Krummel R (1982) Prophylactic antibiotics as an adjunct for skin grafting in clean reconstructive surgery following burn injury. J Trauma 22:687–690CrossRefPubMed
28.
Avni T, Levcovich A, Ad-El DD, Leibovici L, Paul M (2010) Prophylactic antibiotics for burns patients: systematic review and meta-analysis. BMJ 340:c241CrossRefPubMedPubMedCentral
29.
Baran CN, Sensoz O, Ulusoy MG (1999) Prophylactic antibiotics in plastic and reconstructive surgery. Plast Reconstr Surg 103:1561–1566CrossRefPubMed
30.
Hauck RM, Nogan S (2013) The use of prophylactic antibiotics in plastic surgery: update in 2010. Ann Plast Surg 70:91–97CrossRefPubMed
31.
Aydin N, Uraloglu M, Yilmaz Burhanoglu AD, Sensoz O (2010) A prospective trial on the use of antibiotics in hand surgery. Plast Reconstr Surg 126:1617–1623CrossRefPubMed
32.
Bykowski MR, Sivak WN, Cray J, Buterbaugh G, Imbriglia JE, Lee WP (2011) Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8,850 cases. J Hand Surg Am 36:1741–1747CrossRefPubMed
33.
Mundinger GS, Borsuk DE, Okhah Z, Christy MR, Bojovic B, Dorafshar AH, Rodriguez ED (2015) Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice. Craniomaxillofac Trauma Reconstr 8:64–78CrossRefPubMed
34.
Gonzalez-Castro J, Lighthall JG (2016) Antibiotic use in facial plastic surgery. Facial Plast Surg Clin North Am 24:347–356CrossRefPubMed
35.
Casaer B, Tan EK, Depoorter M (2009) The role of antibiotic prophylaxis in abdominoplasty: a review of the infection rate in 300 cases treated without prophylaxis. Plast Reconstr Surg 123:42eCrossRefPubMed
36.
Chaouat M, Levan P, Lalanne B, Buisson T, Nicolau P, Mimoun M (2000) Abdominal dermolipectomies: early postoperative complications and long-term unfavorable results. Plast Reconstr Surg 106:1614–1623CrossRefPubMed
37.
Baker KA (2000) Antibiotic prophylaxis for selected implants and devices. J Calif Dent Assoc 28:620–626PubMed
38.
Friedlander AH (2009) Presence of staphylococci in mouth and presence of streptococci in late infections of knee and hip joint prostheses: antibiotic prophylaxis, a conundrum. Spec Care Dentist 29:226–228CrossRefPubMed
39.
Lockhart PB, Garvin KL, Osmon DR, Hewlett AL, Scuderi G, Lewallen D, Vail T (2013) The antibiotic prophylaxis guideline for prosthetic joints: trying to do the right thing. J Am Acad Orthop Surg 21:193–194PubMed
40.
Marculescu CE, Osmon DR (2005) Antibiotic prophylaxis in orthopedic prosthetic surgery. Infect Dis Clin N Am 19:931–946CrossRef
41.
Skaar DD, Park T, Swiontkowski MF, Kuntz KM (2015) Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: comparisons of antibiotic regimens for patients with total hip arthroplasty. J Am Dent Assoc 146:830–839CrossRefPubMed
42.
Huang N, Liu M, Yu P, Wu J (2015) Antibiotic prophylaxis in prosthesis-based mammoplasty: a systematic review. Int J Surg 15:31–37CrossRefPubMed
43.
Clayton JL, Bazakas A, Lee CN, Hultman CS, Halvorson EG (2012) Once is not enough: withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of infection. Plast Reconstr Surg 130:495–502CrossRefPubMedPubMedCentral
44.
Townley WA, Baluch N, Bagher S, Maass SW, O’Neill A, Zhong T, Hofer SO (2015) A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: a matched cohort study. J Plast Reconstr Aesthet Surg 68:673–678CrossRefPubMed
45.
Krasny M, Krasny K, Zadurska M, Fiedor P (2016) Evaluation of treatment outcomes and clinical indications for antibiotic prophylaxis in patients undergoing implantation procedures. Adv Med Sci 61:113–116CrossRefPubMed
Metadata
Title
Antibiotic prophylaxis: current recommendations in plastic surgery
Authors
Shana S. Kalaria
Thanapoom Boonipat
J. Michael Smith
Eric L. Cole
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 5/2019
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-018-1492-2

Other articles of this Issue 5/2019

European Journal of Plastic Surgery 5/2019 Go to the issue

Original Paper

Outcomes of prepectoral implant-based breast reconstruction with Braxon® acellular dermal matrix—a single-centre experience

Original Paper

Danish and Dutch linguistic validation and cultural adaptation of the WOUND-Q, a PROM for chronic wounds

Case Report

Radiation-associated angiosarcoma after autologous breast reconstruction: report of two cases in a plastic surgery unit

Original Paper

Single centre review of the use of costal cartilage for reconstruction of the nasal dorsum

Review

Literature scans: cartilage grafts in nasal tip rhinoplasty

Ideas and Innovations

A novel technique for the safe transfer of the pedicle of a free flap in head and neck reconstruction using a nasopharyngeal airway connected to a negative pressure suction