In Vitro Evaluation of Common Antimicrobial Solutions Used for Breast Implant Soaking and Breast Pocket Irrigation – Part 1: Efficacy Against Planktonic Bacteria
Abstract Background Planktonic bacteria can be inadvertently introduced during breast surgery procedures, which are hypothesized to lead to complications such as infection, capsular contracture, BIA-ALCL, and a prolonged local inflammatory response. The use of antimicrobial solutions such as triple antibiotic solution (TAB) and/or 10% povidone-iodine (PI), in breast pocket irrigation or implant soaking have been proposed to reduce planktonic bacterial attachment and potential complications. Objectives A series of in vitro assessments were performed to evaluate the antimicrobial utility of triple antibiotic solution (TAB) and PI, either alone or in combination, against planktonic bacteria. Methods Planktonic gram-positive and gram-negative bacterial strains were exposed to TAB and PI +/- TAB for up to 10 minutes in a bacterial time-kill assay. Efficacy of various dilutions of PI as well as the effects of serum protein on PI efficacy were also investigated. Results TAB was ineffective at the timeframes tested (≤ 10 minutes) when used alone; however, when used with PI, significant log reduction of all tested planktonic species was achieved. PI alone was also effective, even including dilute concentrations (e.g., 0.5% PI), although the presence of serum proteins required higher concentrations of PI (e.g., 2.5%) to eradicate the bacterial load. Conclusions Our data suggest PI-containing solutions may be preferred over either saline or TAB without PI for primary breast pocket irrigation and implant soaking in primary breast surgeries as a means to significantly reduce planktonic bacteria. These data provide an impetus for surgeons to re-evaluate the efficacy of TAB solution in these clinical settings.