DETERMINANTS OF SURGICAL SITE INFECTIONS AFTER BREAST SURGERY; OUR INSTITUTE EXPERIENCE.

Background:- Surgical site infections (SSIs) following breast surgery result in increased length of hospital stay, antibiotic utilization, and morbidity. Understanding SSI risk factors is essential to develop infection prevention strategies and improve surgical outcomes. This study aimed to identify the determinants of SSIs after different breast surgical procedures regarding incidence rate, grades, causative organism(s), risk factors and management at Alexandria Medical Research Institute hospital. Methods:- The study prospectively included all patients admitted to the department of Surgery, Alexandria Medical Research Institute hospital during the period from May 2014 to April 2015 who were planned for breast surgery. Patients were followed up for 30 days after surgery if no prosthesis was placed during the operation and for one year if prosthesis was placed. The determinants of SSIs regarding incidence rate, grades, causative organism(s), risk factors and management were registered. Results:- The study included 282 patients of whom 31 (11%) developed SSIs. All patients with SSI have been detected during the outpatient follow up within the first 3 weeks after surgery except 4 cases; Two cases with implants (3 and 6 months after surgery) and 2 cases with expanders (7 and 9 months after surgery). Staphylococcus aureus was the most common pathogen (42%). Twelve patients (38.7%) were readmitted for management of SSI. The incidence of SSI had statistically significant association with age ?60 years, smoking, diabetes, neoadjuvant chemotherapy, BMI >35, type of surgical procedure, prosthesis placement (implant or expander) and seroma formation (P= 0.003, 0.002, 0.04, 0.03, 0.01, 0.03, 0.02 and 0.03 respectively). Conclusion: SSIs after breast surgery are not uncommon complication and can occur after any type of breast surgery. Microbiological diagnosis (culture and sensitivity testing) is recommended for every case with SSI with the use of empirical broad-spectrum antimicrobial coverage until culture results become available. The incidence of SSI had statistically significant association with age ?60 years, smoking, diabetes, neoadjuvant chemotherapy, BMI >35, type of surgical procedure, prosthesis placement (implant or expander) and seroma formation.