Table 2.

Details of Local Delivery Intervention

Study	Intervention Type and Group Sizes	Antibiotics and Dosages	Treatment Course	Primary Outcome Measures	Study Weaknesses
Xue et al, 2020	Salvage, antibiotic-loaded PMMA plate (45 breasts) OR explantation (17 breasts)	Vancomycin (3 g) and tobramycin (2.2 g)	Periprosthetic infections unresponsive to IV antibiotics underwent either explantation or device exchange with placement of antibiotic impregnated PMMA plate.	Rate of infection clearance (defined by a negative drain culture), abandonment of reconstruction, and successful TE to implant exchange	Variable demographics between groups (comparison group had a worse comorbidity profile), lack of randomization (potential for selection bias), lack of tailored antibiotic regimen to match culture data, retrospective study
Kim et al, 2020	Salvage, continuous vancomycin irrigation to infected breast pocket for a mean time of 11 days (5 breasts) OR explantation (16 breasts)	Vancomycin (1 g/L) irrigation at 250 mL/h for a mean duration of 11 days	Periprosthetic infections unresponsive to IV antibiotics underwent either explantation or antibiotic irrigation of infected pocket with placement of percutaneous catheters in the periexpander cavity under local anesthesia.	Rate of infection clearance and completion of reconstruction, mean cost of treatment	Small sample size, lack of comprehensive outcome measures, lack of tailored antibiotic regimen to match culture data, uneven distribution of adjuvant therapy rates across the study groups, retrospective study design
Sherif et al, 2017	Salvage, absorbable antibiotic beads (12 patients)	Vancomycin (1 g) and tobramycin (1.2 g)	Periprosthetic infections unresponsive to IV antibiotics underwent explantation, pocket lavage, and placement of antibiotic-infused calcium sulfate beads in the breast pocket with a new expander.	Rate of infection clearance	Small sample size, noncomparative study, lack of tailored antibiotic regimen to match culture data, short follow up period (mean, 10.6 months), retrospective study design
Albright et al, 2016	Salvage, antibiotic-loaded PMMA plate OR beads (14 patients)	Vancomycin (2 g) and tobramycin (2.2 g)	Periprosthetic infections unresponsive to IV antibiotics underwent either explantation or device exchange with placement of antibiotic impregnated PMMA plate or beads. Plate and beads removed at time of TE to implant exchange.	Implant pocket sterilization (defined by 2 or more consecutive negative fluid cultures), reoperation for pain or capsular contracture, and infection recurrence (7.1%) were all recorded.	Small sample size, mixed intervention methodology (PMMA plates vs beads), noncomparative study, lack of tailored antibiotic regimen to match culture data, short follow-up period (mean, 8.2 months), retrospective study design
Lapid, 2011	Salvage, implant replacement + gentamicin-infused collagen sponge AND post-op systemic antibiotics (4 patients)	Gentamicin (130 mg)	Periprosthetic infections unresponsive to IV antibiotics underwent explantation, pocket lavage, and replacement of implant with addition of gentamicin-infused collagen sponge. Patients then received a 6-week course of postoperative oral antibiotic regimen.	Infection clearance and implant salvage were primary outcome measures. The presence of capsular contracture was also recorded.	Case series, inadequate description of cases, lack of standardization between patients, use of extensive systemic antibiotic therapy, lack of tailored antibiotic regimens to match culture data
Kenna et al, 2018	Prophylaxis, reconstruction with standard methods (59 patients) OR standard methods + absorbable antibiotic beads (68 breasts)	Vancomycin (0.5 g) and gentamicin (0.24 g)	All patients received immediate, submuscular TE placement. Intervention group had antibiotic-impregnated calcium sulfate beads placed in the pocket along with the expander.	Rate of tissue expander loss secondary to infection	Variable demographics between groups (intervention group had higher BMI, incidence of diabetes, smoking, chemotherapy, and radiation therapy), lack of randomization into treatment vs control groups (sequential enrollment), retrospective study design
Hunsicker et al, 2017	Prophylaxis, continuous vancomycin irrigation into periexpander space for 4 days (163 patients) OR infusion of local anesthetic alone (113 patients)	Irrigation with vancomycin-based triple-antibiotic solution (1 g vancomycin, 80 mg gentamicin, 50,000 IU bacitracin per L) at 4 mL/h for 96 hours	All patients had a catheter and 2 drains placed in the breast pocket. Control group received irrigation with ropivacaine, treatment group also had an antibiotic solution infused into the breast pocket. After 96 hours of irrigation, catheters of both groups were removed.	The incidence of periprosthetic infection was the primary outcome measure. The rate of other surgical complications, such as seroma, hematoma, and skin necrosis were also recorded.	Short follow-up period (6 weeks), subdivision of the intervention group (textured vs smooth implants), uneven baseline patient metrics between study groups, retrospective study design
Tutela et al, 2015	Prophylaxis, continuous irrigation with gentamicin-based triple-antibiotic solution for 24 hours after surgery (34 patients) OR standard methods (45 patients)	Irrigation with gentamicin-based triple antibiotic solution (80 mg gentamicin, 1 g cefazolin, 50,000 IU bacitracin) at 40 mL/h for 24 hours	Patients underwent immediate submuscular TE placement. Intervention group received antibiotic irrigation system in the pocket. Antibiotic irrigation continued for 24 hours after surgery then was discontinued.	Rates of infection and premature explantation were primary outcome measures. The rates of hematoma and seroma formation were also recorded.	Follow-up time not described, few patient demographics reported, few outcome measures recorded, nonrandomized, heterogeneous sample population

Abbreviations: IV, intravenous; PMMA, polymethylmethacrylate; TE, tissue expander.