Prophylactic Antibiotic Use in Breast Cancer Surgery Patients

Background: Despite the risks of contributing to antibiotic resistance, guidelines recommend antibiotic prophylaxis for plastic surgery. Aim: To evaluate institutional antibiotic prescribing patterns for breast cancer surgery. Method: As there are no national antibiotic prophylaxis guidelines for breast cancer surgery, the Therapeutic Guidelines: Antibiotic for head, neck and thoracic surgery were the most appropriate reference point. Data were reviewed for 95 patients from 1 hospital who underwent 134 breast cancer operations performed by 12 surgeons over a 6-month period in 2012. A bivariate scoring system (in agreement/ not in agreement) assessed each surgical record against 4 criteria: antibiotic, route, timing of administration, dosage. A conservative assumption, that all surgical cases would require single-dose antibiotic prophylaxis, was applied. Results: Of the 134 operations (comprising 241 surgical procedures), 71 (53%) involved prophylactic administration of antibiotics, mainly IV cefazolin. 38 of the 71 operations also used postoperative antibiotics. There were no trends between surgeons. None of the cases was in complete agreement with the Therapeutic Guidelines: Antibiotic. Conclusion: The lack of specificity of the Therapeutic Guidelines: Antibiotic may account for the observed divergence in antibiotic prescribing patterns. Guidelines for breast cancer surgery are needed that are based on consultation with surgeons and balance specificity with flexibility for the surgeon's judgement of infection risk