Background and Objectives. Surgical site infection (SSI) is the most common postoperative complication associated with breast cancer surgery. The present investigation aimed to determine the SSI rate after breast cancer surgeries and the causative microorganisms. Patients and Methods. All patients who underwent breast surgery in Kuwait Cancer Control Center as a treatment for breast cancer from January 2009–December 2010 were prospectively followed for the development of SSI. Indirect detection was used to identify SSIs through medical record to review and discussion with the treating surgeons. Results. The number of operations was 438. Females represented 434 (99.1%) cases while males constituted only 4 (0.9%) cases. SSIs were diagnosed after 10 operations, all for female cases. Most of the SSIs (8 cases; 80%) were detected after patients were discharged, during outpatient followup. Out of those 5/8; (62.5%) were readmitted for management of SSI. Nine patients (90%) received systemic antibiotic therapy for management of their wound infection. The SSI rate was 2.3%. The main causative organism was Staphylococcus aureus (S. aureus) which was responsible for 40% of infections. Gram negative bacteria were isolated from 40% of the cases. Conclusion. SSI is an important complication following breast cancer surgery. Microbiological diagnosis is an essential tool for proper management of such patients. 1. Introduction Breast cancer is one of the most frequent malignancies in women worldwide [1]. In Kuwait, it ranked first among both Kuwaiti and non-Kuwaiti women. During the period from 2000 to 2008, it constituted 36.0% and 39.5% from the newly diagnosed cancer cases in Kuwaiti and non-Kuwaiti females, respectively [2]. Excision of the primary tumor (by mastectomy or breast conserving surgery) and sentinel lymph node or axillary lymph node dissection are standard procedures for the treatment of most cases [1]. Surgical site infection (SSI) is the most common postoperative complication associated with breast cancer surgery [3]. The development of SSI can lead to prolonged hospital stay with increased costs, poor cosmetic results, psychological trauma, and, occasionally, a delay in postoperative adjuvant therapies [4]. To the best of our knowledge, no published studies reported SSI rate after breast cancer surgery in Kuwait. Hence, the present investigation was aiming to determine the SSI rate after breast cancer surgeries and the causative microorganisms as a step to improve the management and the outcome of such patients. 2. Subjects and Methods All patients
References
[1]
A. Lucci, L. M. McCall, P. D. Beitsch et al., “Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group trial Z0011,” Journal of Clinical Oncology, vol. 25, no. 24, pp. 3657–3663, 2007.
[2]
Ministry of Health, Kuwait cancer registry 2000–2008.
[3]
W. A. B. Felippe, G. L. Werneck, and G. Santoro-Lopes, “Surgical site infection among women discharged with a drain in situ after breast cancer surgery,” World Journal of Surgery, vol. 31, no. 12, pp. 2293–2299, 2007.
[4]
K. R. Wedgwood, E. A. Benson, and B. Hogbin, “Non-tumour morbidity and mortality after modified radical mastectomy,” Annals of the Royal College of Surgeons of England, vol. 74, no. 5, pp. 314–317, 1992.
[5]
A. J. Mangram, T. C. Horan, M. L. Pearson, L. C. Silver, W. R. Jarvis, and Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee, “Guideline for prevention of surgical site infection,” American Journal of Infection Control, vol. 27, no. 2, pp. 97–132, 1999.
T. C. Horan, M. Andrus, and M. A. Dudeck, “CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting,” American Journal of Infection Control, vol. 36, no. 5, pp. 309–332, 2008.
[8]
K. Rolston, C. Mihu, and J. Tarrand, “Current Microbiology of surgical site infections associated with breast cancer surgery,” Wounds, vol. 22, no. 5, pp. 132–135, 2010.
[9]
A. C. Degnim, A. D. Throckmorton, S. Y. Boostrom et al., “Surgical site infection after breast surgery: impact of 2010 CDC reporting guidelines,” Annals of Surgical Oncology, vol. 19, pp. 4099–4103, 2012.
[10]
S. Leinung, M. Sch？nfelder, K. J. Winzer et al., “Wound infection and infection-promoting factors in breast cancer surgery—a prospective multicenter study on quality control,” Zentralblatt für Chirurgie, vol. 130, no. 1, pp. 16–20, 2005.
[11]
M. A. Olsen, S. Chu-Ongsakul, K. E. Brandt, J. R. Dietz, J. Mayfield, and V. J. Fraser, “Hospital-associated costs due to surgical site infection after breast surgery,” Archives of Surgery, vol. 143, no. 1, pp. 53–60, 2008.
[12]
D. Vilar-Compte, S. Rosales, N. Hernandez-Mello, E. Maafs, and P. Volkow, “Surveillance, control, and prevention of surgical site infections in breast cancer surgery: a 5-year experience,” American Journal of Infection Control, vol. 37, no. 8, pp. 674–679, 2009.
[13]
K. Sands, G. Vineyard, and R. Platt, “Surgical site infections occurring after hospital discharge,” Journal of Infectious Diseases, vol. 173, no. 4, pp. 963–970, 1996.
[14]
E. Prospero, A. Cavicchi, S. Bacelli, P. Barbadoro, L. Tantucci, and M. M. D'Errico, “Surveillance for surgical site infection after hospital discharge: a surgical procedure-specific perspective,” Infection Control and Hospital Epidemiology, vol. 27, no. 12, pp. 1313–1317, 2006.
[15]
A. D. Throckmorton, L. M. Baddour, T. L. Hoskin, J. C. Boughey, and A. C. Degnim, “Microbiology of surgical site infections complicating breast surgery,” Surgical Infections, vol. 11, no. 4, pp. 355–359, 2010.
[16]
R. A. Mukhtar, A. D. Throckmorton, M. D. Alvarado et al., “Bacteriologic features of surgical site infections following breast surgery,” American Journal of Surgery, vol. 198, no. 4, pp. 529–531, 2009.
