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

Amy C. Degnim, Tanya L. Hoskin, Rushin D. Brahmbhatt, Anne Warren-Peled, Margie Loprinzi, Emily S. Pavey, Judy C. Boughey, Tina J. Hieken, Steven Jacobson, Valerie Lemaine, James W. Jakub, Chetan Irwin, Robert D. Foster, Hani Sbitany, Michel Saint-Cyr, Erin Duralde, Sheri Ramaker, Robin Chin, Monica Sieg, Melissa WildemanJeffrey S. Scow, Robin Patel, Karla Ballman, Larry M. Baddour, Laura J. Esserman

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)3240-3248
Number of pages9
JournalAnnals of Surgical Oncology
Volume21
Issue number10
DOIs
StatePublished - Jan 1 2014

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

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    Degnim, A. C., Hoskin, T. L., Brahmbhatt, R. D., Warren-Peled, A., Loprinzi, M., Pavey, E. S., Boughey, J. C., Hieken, T. J., Jacobson, S., Lemaine, V., Jakub, J. W., Irwin, C., Foster, R. D., Sbitany, H., Saint-Cyr, M., Duralde, E., Ramaker, S., Chin, R., Sieg, M., ... Esserman, L. J. (2014). Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction. Annals of Surgical Oncology, 21(10), 3240-3248. https://doi.org/10.1245/s10434-014-3918-9