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Study: Routine Antibiotics for Breast-
Oncology Times • June 25, 2015 • oncology-times.com
Conserving Surgery Can Be Safely Omitted
By Ed Susman
O
RLANDO, Fla.—Providing
prophylactic antibiot-
ics to prevent infections
in women undergoing
breast cancer needle-directed lumpec-
tomy procedures may be wasted ef-
forts, researchers suggested here at the
American Society of Breast Surgeons
(ASBrS) Annual Meeting.
“Our analysis showed no difference
in infection rate, leading to the con-
clusion that it is safe to omit the use
of antibiotics prior to needle-localized
lumpectomy and avoid the cost of the
medication, patient adverse reactions,
and the increased risk of resistant or-
ganisms,” said Lindsay Petersen, MD,
Senior Resident in General Surgery at
Rush University in Chicago and sched-
uled to start in July as a Fellow in Breast
Surgery at the University of Michigan.
Of the 140 patients in the study who
were not given prophylactic antibiotics,
only three developed infections—a rate
“We are being
much too cautious
in ordering
antibiotics in
patients undergoing
these procedures. of two percent, compared with one per-
We are not violating cent (one infection) in the 80 patients
given antibiotics, she noted in an inter-
anything other than view at her poster presentation.
“We are being much too cautious in
the skin and soft ordering antibiotics in patients under-
so there should not going these procedures,” she said. “We
are not violating anything other than
be a great risk for the skin and soft tissue so there should
not be a great risk for infection.”
infection.” Karen Kostroff, MD, Chief of Breast
Surgery at North Shore-LIJ Cancer
“The fears that
longer wait times
for surgery and
more exposure to
the needle lead
to higher infection
rates have not been
justified by data we
reviewed.”
Institute in Lake Success, N.Y., con-
curred with the findings: “I have not
routinely given antibiotics to patients
undergoing uncomplicated breast can-
cer surgery unless they are undergoing
reconstruction,” she said.
“If surgeons have been using antibi-
otics when a wire localization has been
done, this study certainly would sup-
port their discontinuing that practice.
We do tend to over-utilize antibiotics,
which expose patients to allergic reac-
tions, resistance to antibiotics in the fu-
ture, and increased costs.”
Contrary to ASBrS
Position Statement
The findings appear contrary to the
American Society of Breast Surgeons
position statement on antibiotics and
surgical site infections (http://bit.
ly/1AsS2ES), which were released in
2012. “Those guidelines recommend
a preoperative prophylactic dose of
an antibiotic prior to needle-localized
lumpectomy for cancer or prior to
any excisional biopsy if risk factors are
present, but it is unclear if this practice
reduces the rate of infection,” Petersen
said.
For the study, she and her colleagues
conducted a retrospective chart review
of patients who underwent needle-
localized lumpectomy from 2010 to
2012, collecting data on patient demo-
graphics, comorbid conditions, medical
history, operative details, and pathology.
Surgical infections requiring opening of
the wound or treatment with antibiotics
were documented if they occurred during
the first three months following surgery.
During the study period, a total
of 220 patients underwent needle-
localized lumpectomy at one Chicago
institution. Their mean age was 57, and
average body mass index was 32 kg/m2.
About 14 percent of the patients were
smokers. The mean duration of sur-
gery was 92 minutes. The mean dura-
tion of time the needle was in place was
233 minutes. Thirty eight percent of
patients had malignant pathology.
A greater percentage of patients un-
dergoing re-excision procedures were
given antibiotics—15 of 80 patients
(19 percent) compared with 13 of 140
patients (9%) not given antibiotics.
All other differences between the
groups—diabetes status, radiation,
neoadjuvant chemotherapy, and malig-
nant pathology—were not significantly
different, Petersen said. Most of the 80
Ed Susman
Lindsay Petersen, MD: “Our
analysis showed no difference
in infection rate, leading to the
conclusion that it is safe to omit
the use of antibiotics prior to
needle-localized lumpectomy and
avoid the cost of the medication,
patient adverse reactions, and
increase in resistant organisms.”
patients who received antibiotics were
treated with cefazolin (79%); another
19 percent received clindamycin, one
patient received ertapenem, and an-
other received levofloxacin.
Petersen said that after examining
the patient characteristics of the four
individuals who developed an infection
and the 216 patients who did not, she
was unable to find any significant cor-
relations. Although three of the four pa-
tients with infections (75%) were older
than 65, 71 percent of the women who
did not have infections were also over
65; four patients with an infection had
received antibiotics (24%) and 37% of
the patients who did not have an infec-
tion received antibiotics. Two of the
four women undergoing lumpectomy
who had infections had a malignancy
diagnosis compared with 38 percent of
the women without infection.
“The fears that longer wait times for
surgery and more exposure to the nee-
dle lead to higher infection rates have
not been justified by data we reviewed,”
Petersen summed up. She said there
have been no studies that addressed
the question of whether long-term nee-
dle exposure in the breast is linked to
infection.
In the study, 215 of 216 patients who
did not have infection had the needle in
place for at least 90 minutes, but none
of the women with infections had the
needle in place for longer than that.
Length of surgery also did not appear to
make a difference: About 98 percent of
the patients who did not have infections
were in surgery for more than 45 min-
utes compared with none of the women
who did have infections.  OT