60. Non-oncologic Breast Surgery Infection Bacteriology: Insights and Implications for Empiric Management

PURPOSE: Despite prophylactic antibiotic use, surgical site infections in breast surgery are common and concerning due to their associated morbidity and costs. While infection rates for oncologic breast surgery range are higher at approximal 15%, non-oncologic procedures report lower infection rates, typically under 1%. However, limited data exist on infection rates, bacteriology, and antibiotic sensitivities specific to non-oncologic breast surgeries. This study aimed to identify infection rates for non-oncologic breast surgeries at a single institution and recommend empiric antibiotics for each procedure type based on the unique organism profiles and antibiotic sensitivities. METHODS: A retrospective cohort study was conducted at a tertiary academic hospital from November 2018 to January 2024. Patients included were aged ≥18 years, had undergone non-oncologic breast surgery, and had culture-confirmed infections. Procedures analyzed included mastopexy, breast augmentations, reductions, gender affirming procedures, prophylactic mastectomies with and without reconstruction, and tissue expander placement. Organism profiles for procedures with more than 1 culture positive infection were compared with their antibiogram. RESULTS: A total of 3,464 non-oncologic breast surgeries were performed during the study period, with 38 culture-positive infections, yielding an overall infection rate of 1.10%. Patients with infections were older on average (44 vs 37 years, p<0.05), but there were no significant differences in sex, BMI, tobacco use, or preoperative comorbidities between the infection and non-infection groups. The most commonly cultured organisms varied by procedure type. For example, reductions had a higher incidence of similar organisms, while mastopexies had polymicrobial infections with greater variability in pathogens. Based on the antibiogram analysis, empiric antibiotic recommendations were made for each procedure type. All procedures had organisms that were sensitive to vancomycin. For procedures specific empiric coverage, we ultimately recommended vancomycin and the addition of ciprofloxacin, piperacillin-tazobactam, levofloxacin or ceftazidime depending on the procedure. CONCLUSION: This study demonstrates that infection rates in non-oncologic breast surgeries are low, aligning with literature estimates. The variability in organism profiles by procedure type suggests that surgery-specific empiric antibiotic regimens may help optimize infection management while awaiting culture results. Tailoring empiric antibiotics to the most likely pathogens could reduce the need for surgical debridement or prosthetic removal, improving patient outcomes.