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DOI: 10.1055/s-0041-1736300
Intraoperative Assessment of Endogenous Microbiota in the Breast
Avaliação intraoperatória da microbiota endógena da mamaAbstract
Objective: Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast.
Methods: Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconstructive, diagnostic, or oncologic) were cultured. The pieces of breast tissue were approximately 1 cm in diameter and were removed from the retroareolar area, medial quadrant, and lateral quadrant. Each piece of tissue was incubated in brain heart infusion (BHI) broth for 7 days at 37°C, and in cases in which the medium became turbid due to microorganism growth, the samples were placed in Petri dishes for culturing and isolating strains and for identifying species using an automated counter.
Results: Microorganism growth was observed in the samples of 10 of the 49 patients (20.4%) and in 11 of the 218 pieces of tissue (5%). The detected species were Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis, and Aeromonas salmonicida. No patient with positive samples had clinical infection postoperatively.
Conclusion: The presence of these bacteria in breast tissue in approximately 20% of the patients in this series suggests that breast surgery should be considered a potential source of contamination that may have implications for adverse reactions to breast implants and should be studied in the near future for their oncological implications in breast implant-associated large-cell lymphoma etiology.
Resumo
Objetivo: A cirurgia de mama é considerada uma cirurgia limpa; entretanto, as taxas de infecção variam entre 3 e 15%. O objetivo deste estudo foi investigar no intraoperatório a presença de microbiota autóctone na mama.
Métodos: Pedaços de tecido mamário coletados de 49 pacientes submetidas à cirurgia eletiva da mama (reconstrutiva, diagnóstica ou oncológica) foram cultivados. Os pedaços de tecido mamário tinham aproximadamente 1 cm de diâmetro e foram removidos da área retroareolar e dos quadrantes medial e lateral. Cada pedaço de tecido foi incubado em caldo BHI (brain heart infusion) por 7 dias a 37 ° C, e nos casos em que o meio ficou turvo devido ao crescimento de microrganismos, as amostras foram colocadas em placas de Petri para cultivo e isolamento de cepas e para identificação de espécies usando um contador automatizado.
Resultados: O crescimento do microrganismo foi observado nas amostras de 10 das 49 pacientes (20,4%) e em 11 dos 218 pedaços de tecido (5%). As espécies detectadas foram Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis e Aeromonas salmonicida. Nenhum paciente com amostras positivas apresentou infecção clínica no pós-operatório.
Conclusão: A presença dessas bactérias no tecido mamário em aproximadamente 20% das pacientes desta série sugere que a cirurgia mamária deve ser considerada uma fonte potencial de contaminação que pode ter implicações nas reações adversas aos implantes mamários e deve ser estudada em um futuro próximo por suas implicações oncológicas na etiologia do linfoma de células grandes associado ao implante de mama.
Keywords
surgery infection - capsular contracture - nipple-sparing mastectomy - breast conservative surgery - biofilmPalavras-chave
infecção cirúrgica - contratura capsular - mastectomia com preservação do mamilo - cirurgia conservadora da mama - biofilmePublication History
Received: 25 January 2021
Accepted: 26 August 2021
Article published online:
16 November 2021
© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Ministério da Saúde. Portaria No. 930, de 27 de agosto de 1992. Dispõe sobre normas para controle das infecções hospitalares. Diário Oficial da União. Seç 1992; 1: 12279-12281
- 2 Kataria K, Bagdia A, Srivastava A. Are breast surgical operations clean or clean contaminated?. Indian J Surg 2015; 77 (Suppl. 03) 1360-1362 DOI: 10.1007/s12262-015-1252-5.
- 3 Agarwal S, Ettinger RE, Kung TA, Kozlow JH, Brown DL. Cohort study of immediate implant exchange during acute infection in the setting of breast reconstruction. J Plast Reconstr Aesthet Surg 2017; 70 (07) 865-870 DOI: 10.1016/j.bjps.2017.03.010.
- 4 Ismail A, Mirza M, Sintler M, Hoar F, Vishwanath L. How clean is breast surgery? An audit of surgical site infection rates in breast operations. Eur J Surg Oncol 2016; 42 (05) S12 DOI: 10.1016/j.ejso.2016.02.055.
- 5 Wixtrom RN, Stutman RL, Burke RM, Mahoney AK, Codner MA. Risk of breast implant bacterial contamination from endogenous breast flora, prevention with nipple shields, and implications for biofilm formation. Aesthet Surg J 2012; 32 (08) 956-963 DOI: 10.1177/1090820X12456841.
- 6 Rieger UM, Mesina J, Kalbermatten DF, Haug M, Frey HP, Pico R. et al. Bacterial biofilms and capsular contracture in patients with breast implants. Br J Surg 2013; 100 (06) 768-774 DOI: 10.1002/bjs.9084.
- 7 Bartsich S, Ascherman JA, Whittier S, Yao CA, Rohde C. The breast: a clean-contaminated surgical site. Aesthet Surg J 2011; 31 (07) 802-806 DOI: 10.1177/1090820X11417428.
- 8 Nava MB, Rancati A, Angrigiani C, Catanuto G, Rocco N. How to prevent complications in breast augmentation. Gland Surg 2017; 6 (02) 210-217 DOI: 10.21037/gs.2017.04.02.
- 9 Hu H, Jacombs A, Vickery K, Merten SL, Pennington DG, Deva AK. Chronic biofilm infection in breast implants is associated with an increased T-cell lymphocytic infiltrate: implications for breast implant-associated lymphoma. Plast Reconstr Surg 2015; 135 (02) 319-329 DOI: 10.1097/PRS.0000000000000886.
- 10 Zar JH. Biostatistical analysis. 5th ed.. Upper Saddle River: Prentice Hall; 2009
- 11 Zhang Y, Dong J, Qiao Y, He J, Wang T, Ma S. Efficacy and safety profile of antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery: a meta-analysis of randomized controlled trials. Ann Plast Surg 2014; 72 (01) 121-130 DOI: 10.1097/01.SAP.0000440955.93769.8c.
- 12 Fernandes A, Dias M. The microbiological profiles of infected prosthetic implants with an emphasis on the organisms which form biofilms. J Clin Diagn Res 2013; 7 (02) 219-223 DOI: 10.7860/JCDR/2013/4533.2732.
- 13 Ajdic D, Zoghbi Y, Gerth D, Panthaki ZJ, Thaller S. The relationship of bacterial biofilms and capsular contracture in breast implants. Aesthet Surg J 2016; 36 (03) 297-309 DOI: 10.1093/asj/sjv177.
- 14 Karau MJ, Greenwood-Quaintance KE, Schmidt SM, Tran NV, Convery PA, Jacobson SR. et al. Microbial biofilms and breast tissue expanders. BioMed Res Int 2013; 2013: 254940 DOI: 10.1155/2013/254940.
- 15 Epstein AK, Pokroy B, Seminara A, Aizenberg J. Bacterial biofilm shows persistent resistance to liquid wetting and gas penetration. Proc Natl Acad Sci U S A 2011; 108 (03) 995-1000 DOI: 10.1073/pnas.1011033108.
- 16 Myckatyn TM, Cohen J, Chole RA. Clarification of the definition of a “biofilm”. Plast Reconstr Surg 2016; 137 (01) 237e-238e DOI: 10.1097/PRS.0000000000001911.
- 17 Bergmann PA, Tamouridis G, Lohmeyer JA, Mauss KL, Becker B, Knobloch J. et al. The effect of a bacterial contamination on the formation of capsular contracture with polyurethane breast implants in comparison with textured silicone implants: an animal study. J Plast Reconstr Aesthet Surg 2014; 67 (10) 1364-1370 DOI: 10.1016/j.bjps.2014.05.040.
- 18 Ye X, Shokrollahi K, Rozen WM, Conyers R, Wright P, Kenner L. et al. Anaplastic large cell lymphoma (ALCL) and breast implants: breaking down the evidence. Mutat Res Rev Mutat Res 2014; 762: 123-132 DOI: 10.1016/j.mrrev.2014.08.002.
- 19 Yalanis GC, Liu EW, Cheng HT. Efficacy and safety of povidone-iodine irrigation in reducing the risk of capsular contracture in aesthetic breast augmentation: a systematic review and meta-analysis. Plast Reconstr Surg 2015; 136 (04) 687-698 DOI: 10.1097/PRS.0000000000001576.
- 20 Clemens MW, Nava MB, Rocco N, Miranda RN. Understanding rare adverse sequelae of breast implants: anaplastic large-cell lymphoma, late seromas, and double capsules. Gland Surg 2017; 6 (02) 169-184 DOI: 10.21037/gs.2016.11.03.
- 21 Bizjak M, Selmi C, Praprotnik S, Bruck O, Perricone C, Ehrenfeld M. et al. Silicone implants and lymphoma: The role of inflammation. J Autoimmun 2015; 65: 64-73 DOI: 10.1016/j.jaut.2015.08.009.
- 22 Adams Jr WP. Discussion: bacterial biofilm infection detected in breast implant-associated anaplastic large-cell lymphoma. Plast Reconstr Surg 2016; 137 (06) 1670-1672 DOI: 10.1097/PRS.0000000000002170.
- 23 Brody GS. The case against biofilm as the primary initiator of breast implant-associated anaplastic large cell lymphoma. Plast Reconstr Surg 2016; 137 (04) 766e-767e DOI: 10.1097/01.prs.0000480003.80422.03.
- 24 Santanelli di Pompeo F, Laporta R, Sorotos M, Di Napoli A, Giovagnoli MR, Cox MC. et al. Breast implant-associated anaplastic large cell lymphoma: proposal for a monitoring protocol. Plast Reconstr Surg 2015; 136 (02) 144e-151e DOI: 10.1097/PRS.0000000000001416.
- 25 Chan AA, Bashir M, Rivas MN, Duvall K, Sieling PA, Pieber TR. et al. Characterization of the microbiome of nipple aspirate fluid of breast cancer survivors. Sci Rep 2016; 6: 28061 DOI: 10.1038/srep28061.
- 26 Lee KT, Pyon JK, Bang SI, Lee JE, Nam SJ, Mun GH. Does the reconstruction method influence development of mastectomy flap complications in nipple-sparing mastectomy?. J Plast Reconstr Aesthet Surg 2013; 66 (11) 1543-1550 DOI: 10.1016/j.bjps.2013.06.032.
- 27 Colwell AS, Tessler O, Lin AM, Liao E, Winograd J, Cetrulo CL. et al. Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. Plast Reconstr Surg 2014; 133 (03) 496-506 DOI: 10.1097/01.prs.0000438056.67375.75.
- 28 Dent BL, Cordeiro CN, Small K, Clemons JA, Kessler EG, Swistel A. et al. Nipple-sparing mastectomy via an inframammary fold incision with implant-based reconstruction in patients with prior cosmetic breast surgery. Aesthet Surg J 2015; 35 (05) 548-557 DOI: 10.1093/asj/sju158.
- 29 Flugstad NA, Pozner JN, Baxter RA, Creasman C, Egrari S, Martin S. et al. Does implant insertion with a funnel decrease capsular contracture? A preliminary report. Aesthet Surg J 2016; 36 (05) 550-556 DOI: 10.1093/asj/sjv237.
- 30 Göker T, Aşık RZ, Yılmaz MB, Çelik İ, Tekiner A. Sphingomonas paucimobilis: a rare infectious agent found in cerebrospinal fluid. J Korean Neurosurg Soc 2017; 60 (04) 481-483 DOI: 10.3340/jkns.2014.0102.004.
- 31 Yeh CF, Chang SC, Cheng CW, Lin JF, Liu TP, Lu JJ. Clinical Features, Outcomes, and Molecular Characteristics of Community- and Health Care-Associated Staphylococcus lugdunensis Infections. J Clin Microbiol 2016; 54 (08) 2051-2057 DOI: 10.1128/JCM.00847-16.
- 32 Büttner H, Mack D, Rohde H. Structural basis of Staphylococcus epidermidis biofilm formation: mechanisms and molecular interactions. Front Cell Infect Microbiol 2015; 5: 14 DOI: 10.3389/fcimb.2015.00014.
- 33 Calkins S, Couger MB, Jackson C, Zandler J, Hudgins GC, Hanafy RA. et al. Draft genome sequence of Staphylococcus hominis strain Hudgins isolated from human skin implicates metabolic versatility and several virulence determinants. Genom Data 2016; 10: 91-96 DOI: 10.1016/j.gdata.2016.10.003.
- 34 Varshney A, Das M, Chaudhary P, Kumari R, Yadav K. Aeromonas salmonicida as a causative agent for postoperative endophthalmitis. Middle East Afr J Ophthalmol 2017; 24 (04) 213-215 DOI: 10.4103/meajo.MEAJO_238_17.