- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01244698
Postoperative Antibiotic Requirements Following Immediate Breast Reconstruction
Antibiotics are used routinely in postoperative tissue expander based breast reconstruction (TE) and autologous flap (AF) breast reconstruction procedures. Closed suction drains are also used routinely in immediate breast reconstruction to prevent fluid accumulation and seroma formation at the surgical sites. Antibiotics are most often prescribed as a precaution since drains can be a source for infection by creating open channels to outside contaminants. Plastic surgery patients without closed suction drainage devices are usually not placed on prolonged postoperative antibiotics. Current preoperative surgical antibiotic prophylaxis is recommended for up to 24 hours only. These recommendations do not take into account the increased risk of indwelling closed suction drains. A recent survey of plastic surgeons, conducted by SBUMC investigators, (IRB# 129415) found that Plastic Surgeons are divided as to extended outpatient administration following TE breast reconstruction.
The study plans to prospectively enroll patients who will undergo immediate breast reconstruction with TE or AF based breast reconstruction. Using the above data and the current protocol, the investigators will investigate the optimal antibiotic discontinuation period for these patients. The investigators hypothesize that the use of 24-hour perioperative antibiotics in TE or AF based immediate breast reconstruction with closed suction drainage, does not result in an increased infection rate compared to prolonged postoperative antibiotic administration.
Study Overview
Status
Intervention / Treatment
Detailed Description
Background:
Antibiotics are used routinely in postoperative tissue expander based breast reconstruction (TE) and autologous flap (AF) breast reconstruction procedures. Closed suction drains are also used routinely in immediate breast reconstruction to prevent fluid accumulation and seroma formation at the surgical sites. Antibiotics are most often prescribed as a precaution because drains may serve as an open channel to outside contaminants. Plastic surgery patients without closed suction drainage devices are usually not placed on prolonged postoperative antibiotics. Current preoperative surgical antibiotic prophylaxis is recommended for up to 24 hours only. These recommendations do not take into account the increased risk of indwelling closed suction drains.
Current plastic surgery literature does not provide recommendations or consensus for antibiotic discontinuation following immediate breast reconstruction. A recent survey conducted of 650 plastic surgeons showed that 98% of respondents give preoperative antibiotics, while 91% provide antibiotics for up to 24 hours. Additionally, 71% of respondents prescribe postoperative outpatient antibiotics. There was a divide of when to discontinue antibiotics among plastic surgeons who gave them postoperatively. 46% preferred to continue antibiotics until drain removal, while 52% preferred a specific postoperative day, most commonly day 5 or 7.
In the same survey, the majority (97%) of surgeons use IV Cefazolin as the choice for preoperative prophylaxis and oral Cephalexin (75.4%) and Cefadroxil (14.3%) for outpatient antibiotics. Currently at Stony Brook University Medical Center, patients normally receive 24 hours of IV Cefazolin, followed by postoperative antibiotic prescription for Cefadroxil. Antibiotics are discontinued when the final drain is removed.
The study plans to prospectively enroll patients who will undergo immediate breast reconstruction with TE or AF based breast reconstruction. Using the above data and the current protocol, the investigators will investigate the optimal antibiotic discontinuation period for these patients. The investigators will randomize these patients into two groups. One group will receive the current antibiotic regimen of 24 hours of IV Cefazolin, followed by outpatient Cefadroxil. Antibiotics will be discontinued for this group once the final drain is removed. The other group will only receive 24 hours of IV Cefazolin without any additional outpatient antibiotics, as is recommended for elective clean surgeries. In patients with penicillin allergies or sensitivity, clindamycin, IV and oral is used. The same randomization will apply in these patients.
Rationale for early discontinuation of postoperative antibiotics:
Studies have associated prolonged antimicrobial prophylaxis with development of resistant bacterial strains following surgical procedures. No evidence has been reported supporting practices of continuing antibiotics until drains are removed. A single dose of preoperative IV antibiotics has been suggested to be sufficient prophylaxis for most breast surgery patients discharged home with drains.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
New York
-
Stony Brook, New York, United States, 11792
- Stony Brook University Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All patients presenting to Stony Brook University Medical Center Plastic Surgery clinic for immediate breast reconstruction using a tissue expander.
- Age 18 years or older
Exclusion Criteria
- Delayed or revision implant reconstruction
- Refusal or inability to consent
- Contraindications to surgery as determined by attending physician
- Contraindications to both penicillin/cephalosporin and clindamycin antibiotics (significant allergies)
- Patients with serious existing systemic infection, defined as 2 or more of the following:
Peripheral body temperature >38 degrees Celsius CRP >5g/L Leukocytes > 12,000/microliter
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
OTHER: Antibiotics until Drain Removal
All patients will receive 24 hours of IV Cefazolin, as is universal practice for clean breast surgery.
The control group will receive oral outpatient Cefadroxil until the final drain is removed.
In case of significant penicillin allergy (defined as a history of urticaria or anaphylaxis associated with penicillin) patients will receive Clindamycin.
|
All patients will receive 24 hours of IV Cefazolin, as is universal practice for clean breast surgery.
The control group will receive oral outpatient Cefadroxil (500mg 2 times a day) until the final drain is removed.
This is the normal postoperative regimen.
In case of significant penicillin allergy (defined as a history of urticaria or anaphylaxis associated with penicillin) patients will receive Clindamycin 600mg IV every 6 hours for 24 hours followed by clindamycin 300mg IV every 6 hours.
Other Names:
|
EXPERIMENTAL: Early discontinuation of antibiotics
All patients will receive 24 hours of IV Cefazolin, as is universal practice for clean breast surgery.
The interventional group will then discontinue antibiotics.
|
All patients will receive 24 hours of IV Cefazolin (1g IV every 8 hr), as is universal practice for clean breast surgery.
The interventional group will then discontinue antibiotics.
Clindamycin IV 600mg every 6 hours for 24 hours will be used in penicillin allergic patients.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Surgical Site infection
Time Frame: 365 days after the procedure
|
One or more of the following:
|
365 days after the procedure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Antibiotic Sensitivity
Time Frame: From administration of the antibiotic until discontinuation
|
Assessed by documentation of an allergic or adverse sensitivity reaction including, but not limited to urticaria, itching, rash, anaphylaxis
|
From administration of the antibiotic until discontinuation
|
Clostridium Difficile Colitis
Time Frame: up to 365 days postoperatively
|
C. Difficile colitis will be assessed by documented positive c. difficile toxin assay.
|
up to 365 days postoperatively
|
Antibiotic Resistance
Time Frame: 1 year postoperatively
|
Local wound infections will be cultured and sent for identification and susceptibility.
Alternatively, pathological fluid collections will be aspirated and fluid will be sent for culture and susceptibility.
Resistant strains will be documented and treated with alternative antibiotics.
|
1 year postoperatively
|
Patient compliance
Time Frame: while antibiotics are being administered postoperatively
|
patients will be asked to bring antibiotics to clinic for counting to assess compliance.
|
while antibiotics are being administered postoperatively
|
Cost
Time Frame: while antibiotics are being administered postoperatively
|
Cost will be assessed by multiplying the duration of outpatient postoperative antibiotics by the cost for self-pay prescriptions.
|
while antibiotics are being administered postoperatively
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Duc T Bui, MD, Stony Brook University Medical Center
- Study Director: Brett T Phillips, MD, Stony Brook University Medical Center
- Study Chair: Duc T Bui, MD, Stony Brook University Medical Center
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 160583-3
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Breast Implantation
-
Nanjing Medical UniversityCompletedBreast Implantation
-
AllerganCompletedBreast ImplantationFrance, Spain, Germany, Israel, United Kingdom
-
AllerganCompleted
-
Establishment LabsRecruitingBreast Augmentation | Breast Reconstruction | Mammaplasty | Breast Implant; Complications | Breast Implantation; Methods, Safety and PerformanceCosta Rica
-
Habib KhanLondon Health Sciences CentreCompleted
-
IRCCS San RaffaeleUnknownBreast Cancer | Edema | Seroma | Mastectomy | Breast ImplantationItaly
-
Instituto Valenciano de Infertilidad, IVI VALENCIACompleted
-
Rabin Medical CenterEinat Medical Inc.UnknownRefractive Error | Corneal Implantation | Intraocular Lens ImplantationIsrael
-
Rambam Health Care CampusRecruiting
-
University Hospital, ToulouseCentre National de la Recherche Scientifique, FranceCompletedCochlear ImplantationFrance
Clinical Trials on Cefadroxil until drain removal
-
IRCCS San RaffaeleCompletedPancreatic Fistula | Complication,Postoperative | PROMs | Pancreas DiseaseItaly
-
Peking Union Medical College HospitalPeking University First Hospital; Cancer Institute and Hospital, Chinese Academy... and other collaboratorsCompletedDrainage | PancreaticoduodenectomyChina
-
Peking Union Medical College HospitalUnknownPancreatectomy | Post Procedural DischargeChina
-
University of British ColumbiaUnknown
-
Centre Hospitalier Universitaire, AmiensCompletedPancreatic Neoplasms | Pancreatic DiseaseFrance
-
Technische Universität DresdenGerman Cancer Research CenterRecruiting
-
Wake Forest University Health SciencesNot yet recruitingVentral HerniaUnited States
-
Universitaire Ziekenhuizen KU LeuvenCompletedBreast Cancer | Draining Wound
-
Universita di VeronaCompletedAbdominal Abscess | Pancreatic Fistula | Pancreaticoduodenectomy | Distal PancreatectomyItaly
-
Centre hospitalier de l'Université de Montréal...WithdrawnHead and Neck Neoplasms | Drain Site Complication | Neck Dissection