Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction

• Published in: Annals of surgical oncology 2014-10, Vol.21 (10), p.3240-3248
• Main Authors: Degnim, Amy C., Hoskin, Tanya L., Brahmbhatt, Rushin D., Warren-Peled, Anne, Loprinzi, Margie, Pavey, Emily S., Boughey, Judy C., Hieken, Tina J., Jacobson, Steven, Lemaine, Valerie, Jakub, James W., Irwin, Chetan, Foster, Robert D., Sbitany, Hani, Saint-Cyr, Michel, Duralde, Erin, Ramaker, Sheri, Chin, Robin, Sieg, Monica, Wildeman, Melissa, Scow, Jeffrey S., Patel, Robin, Ballman, Karla, Baddour, Larry M., Esserman, Laura J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antisepsis; Breast Neoplasms - complications; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Oncology; Catheters - adverse effects; Catheters - microbiology; Drainage - adverse effects; Female; Follow-Up Studies; Humans; Mammaplasty; Mastectomy; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Postoperative Care; Prognosis; Prospective Studies; Surgery; Surgical Oncology; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-3918-9

Background In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction. Methods With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: chlorhexidine disc dressing at drain exit site(s) and irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution. Cultures were obtained from bulb fluid at 1 week and at drain removal, and from the subcutaneous drain tubing at removal. Positive cultures were defined as ≥1+ growth for fluid and >50 CFU for tubing. Results Cultures of drain bulb fluid at 1 week (the primary endpoint) were positive in 9.9 % of treatment sides (10 of 101) versus 20.8 % (21 of 101) of control sides ( p  = 0.02). Drain tubing cultures were positive in 0 treated drains versus 6.2 % (6 of 97) of control drains ( p  = 0.03). Surgical site infection occurred within 30 days in 0 antisepsis sides versus 3.8 % (4 of 104) of control sides ( p  = 0.13), and within 1 year in three of 104 (2.9 %) of antisepsis sides versus 6 of 104 (5.8 %) of control sides ( p  = 0.45). Clinical infection occurred within 1 year in 9.7 % (6 of 62) of colonized sides (tubing or fluid) versus 1.5 % (2 of 136) of noncolonized sides ( p  = 0.03). Conclusions Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains, and reduced drain colonization was associated with fewer infections.