Infectious complications after reconstructive surgeries in breast cancer patients: a case report

Introduction. Currently, there is no global consensus regarding the management of breast cancer patients with implant-associated infections. Some studies clearly recommend their removal and surgical debridement with consecutive antimicrobial treatment, while others prefer long-term antibacterial therapy (at least 1 month) with the effectiveness of such conservative approach of 36-73 %. Case description. A 43-year-old patient suffering from BRCA1-positive right breast cancer T2N0M0 (invasive carcinoma of non-specific type G3, ER - 8, PgR - 0, Her-2/Neu - 0, Ki67 (%) - less than 20 %), underwent radical skin-preserving mastectomy on the right with simultaneous implant reconstruction and preventive subcutaneous mastectomy on the left with simultaneous implant reconstruction. Peri-implant infection in the left breast was observed on the 21st day after surgery. Results. The patient received empirical therapy with cefepim. Microbiological examination of the punctate revealed the causative agent of infection - methicillin-resistant Staphylococcus aureus (MRSA) (1*105 CFU/ml). Daptomycin 6 mg/kg/day was added to therapy. After 8 weeks, the patient received oral moxifloxacin 400 once daily, for another 3 weeks. A complete response was achieved. The patient has no signs of infection for 3 years. Conclusion. Long-term etiotropic antibacterial therapy with daptomycin followed by oral moxifloxacin resulted in a stable clinical effect.