Cultures for Infected Breast Implant

Specimen Collection Technique

Obtain multiple tissue samples (minimum 3, optimally 5-6 separate specimens) from different sites around the implant and adjacent tissue using separate sterile instruments for each sample to maximize diagnostic yield 1, 2
Collect tissue specimens, not swabs, as swabs have low sensitivity and high contamination risk; tissue samples should be homogenized for optimal culture results 3
Submit adequate volume: at least 1 mL of fluid or 0.5 g of tissue per specimen, with larger volumes increasing pathogen recovery 4
Inoculate specimens directly into blood culture bottles (1-10 mL of fluid into aerobic bottles, and if anaerobic cultures requested, into anaerobic bottles as well) for greatest accuracy 4

Anaerobic bacterial cultures should be obtained, as anaerobic bacteria including Propionibacterium acnes, Peptostreptococcus, and other anaerobes are identified in breast implant infections and require specific transport media 4

Withhold antibiotics for at least 2 weeks prior to culture collection when medically safe to do so, as this significantly increases the yield of organism recovery 1, 2, 3
If the patient is unstable or antibiotics cannot be safely withheld, obtain cultures immediately after sampling and before administering new antibiotics 3

Two or more cultures yielding the same organism (identical genus, species, and antibiogram) is considered definitive evidence of prosthetic infection 1, 2
Single culture growing highly virulent organisms (S. aureus, E. coli, Pseudomonas) should raise high suspicion for true infection even without confirmatory cultures 1, 3
Single culture with common contaminants (coagulase-negative staphylococci, P. acnes) should be interpreted cautiously in clinical context and not automatically considered definitive infection 1, 2
Request susceptibility testing for all Staphylococcus aureus, Pseudomonas, and predominant Enterobacteriaceae isolates, as these are more likely to harbor resistance 4

Avoid culturing sinus tracts if present, as these are commonly contaminated with commensal skin flora and do not accurately reflect the causative pathogen 3
Do not rely on blood cultures alone, as they provide limited additional information for localized implant infections unless systemic signs are present 5

The most common causative organisms are methicillin-resistant staphylococci (44%) and gram-negative pathogens (26%), including Pseudomonas (13%) and Klebsiella (5%), according to the American Cancer Society, and this information guides the selection of empiric antibiotic regimens 6, 7
Avoid extending postoperative prophylactic antibiotics beyond 24 hours, as this does not reduce infection rates and promotes multidrug-resistant organisms, as recommended by the American Cancer Society 6, 8

Autologous flap reconstruction is considered for high-risk patients, as the infection rate is lower (7% vs 13%), and this is based on guidelines from the American Cancer Society 6, 9
Seromas between acellular dermal matrix and implants increase infection risk (RR 2.47, 95% CI 1.71-3.57), and it is recommended to remove drains when output <30 mL/day, not exceeding 7-14 days, as suggested by the American Cancer Society 6, 10