2122. Can Chlorhexidine Reduce Bacterial Colonization in Surgical Drains and Surgical Site Infections After Breast Cancer Surgery? A Randomized Controlled Trial

Abstract

Background. Breast surgery is considered a clean surgery; however, surgical site infection (SSI) rates are higher than predicted. Postoperative drains remain in situ for several days with an inevitable bacterial colonization and increased risk of SSI. Methods. We conducted a randomized controlled trial from October 2016 to January 2018 in a Mexican cancer center with high SSI prevalence. We included women with elective breast cancer surgery. Patients were randomized to control (standard drain care) or intervention (occlusive dressing with chlorhexidine 2% at the drain exit site). Perioperative management was standardized for both groups. Patient follow‐ups were performed on a weekly basis for at least 30 days. Fluid cultures were performed at the frst and second week as standardized in the laboratory. At the time of drain removal, the inner portion was sectioned and cultured by Maki's semi‐quantitative technique. Bacterial quantifcation was performed using 16 s rRNA‐qPCR assay Culture results of drain fuid and tubing were compared between groups. Results. We included 104 patients with 167 surgical drains. Patients' clinical characteristics (i.e., age, body mass index, comorbidities, clinical stage, preoperative risk, neoadjuvant therapy) were similar in both groups, with no statistical diferences. Bulb fuid cultures at the frst postoperative week were positive in 42.9% of the control group compared with 27.6% of the antiseptic group (P = 0.04). Cultures from the second week assessment were positive in 79.4% of the control group vs. 53.5% of the antiseptic arm (P = 0.001). Cultures from drain‐tubes were positive in 70.2 and 43.8% (P = 0.001) of the control and antiseptic group, respectively (Figure 1). Eleven patients developed an SSI, three (15.4%) from the intervention group, and eight (15.8%) from the control group (P = 0.11). Eighty‐four pathogens were isolated from the control group samples at week 1 vs. 52 from the intervention group. Staphylococci spp. were the most common microorganisms in Week 1, 61.9% control and 35% intervention group. Conclusion. Local antiseptics provide an opportunity to test simple, safe, and low‐cost interventions that may reduce drain bacterial colonization afer breast surgery and potentially decrease infectious complications. Our microbiology fndings question breast tissue sterility.