From the Guidelines
Methicillin-resistant staphylococci are the most common bacteria causing infections after tummy tucks, breast augmentations, and butt augmentations, accounting for 44% of cases, followed by gram-negative pathogens, including Pseudomonas and Klebsiella spp. These bacteria normally colonize the skin and can enter surgical wounds during or after the procedure 1. For prophylaxis, a first-generation cephalosporin like cefazolin (1-2g IV) is typically administered 30-60 minutes before incision, with additional doses for longer procedures. For patients with beta-lactam allergies, clindamycin (600-900mg IV) or vancomycin (15mg/kg IV) can be used. Some key points to consider in preventing these infections include:
- Using preprocedural systemic antimicrobials to reduce the rate of infection 1
- Following a detailed best-practice standardized protocol to reduce the incidence of complications 1
- Considering autologous flap reconstruction instead of implant-based reconstruction for patients at high risk for infection, due to the lower rate of infection with the former procedure 1 If infection occurs post-operatively, treatment often includes antibiotics like trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily), doxycycline (100mg twice daily), or clindamycin (300-450mg four times daily) for 7-10 days, depending on severity. More severe infections may require intravenous antibiotics and surgical drainage. Proper wound care, including keeping the area clean and dry, is essential for prevention, as these procedures create potential spaces where bacteria can proliferate, particularly in areas with skin folds that may trap moisture 1.
From the Research
Common Pathogens in Post-Surgical Infections
- Staphylococcus aureus is a common pathogen associated with post-surgical infections, including those after tummy tuck, breast augmentation, and butt augmentation 2, 3, 4, 5, 6
Characteristics of Staphylococcus aureus
- Staphylococcus aureus is a gram-positive, coagulase-positive pathogen that can cause a wide range of clinical infections 4, 5
- It is a leading cause of bacteremia and infective endocarditis, as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections 5
Risk Factors for Staphylococcus aureus Infections
- Risk factors for Staphylococcus aureus infections include recent surgical procedures, intravascular devices, injection drug use, diabetes, and previous S aureus infection 3
Treatment and Management of Staphylococcus aureus Infections
- Treatment of Staphylococcus aureus infections typically includes antibiotics, such as vancomycin or daptomycin, and source control measures, such as removal of infected devices or drainage of abscesses 3
- Empirical antibiotic treatment should include vancomycin or daptomycin, which are active against MRSA, and once S aureus susceptibilities are known, MSSA should be treated with cefazolin or an antistaphylococcal penicillin 3