Limitations
bacterial infections
IMPLANT INFECTIONS, BACTERIAL INFECTIONS, IMPLANT INFECTION
This study has several limitations. First, we measured the antibiotic concentration in the breast implant pocket by obtaining fluid samples from the surgical drains. This creates a latency because of the small reservoir of fluid in the drain tubes, which is a potential problem for patients with very low drain fluid production. However, we do not believe that this would have had any significant association with our results because the median drain production in this study was 47.5 mL/d and drain tubes can contain only up to a few milliliters. Second, only 26 of 40 patients opted to provide blood samples, but given the negligible levels of antibiotics in the blood samples, we do not believe that this has limited the conclusions of the study. A third limitation is that we did not adjust the antibiotic concentrations for drain output volume per day because the antibiotic irrigation is administered only as a single dose and before the postoperative drain output is known. Therefore, it would not be possible to adjust the doses according to the drain output of the individual patient. A fourth limitation is that we did not stratify the patients according to the subtype of breast reconstruction or patient characteristics. This was not possible because of limited statistical power, although it could have potentially influenced the antibiotic concentration in the implant pocket. Larger studies are needed to investigate how the surgical technique and patient characteristics are associated with the antibiotic concentration in the breast implant pocket. Fifth, this study investigated only how long the antibiotic concentrations in the implant pocket remained above the MIC for the most common bacterial infections in cases of implant infection and not whether this period was sufficient to prevent implant infections. Thus, further studies are needed, including the results from an ongoing randomized placebo-controlled clinical trial