, it ranked first among both kuwaiti and non - kuwaiti women . during the period from 2000 to 2008 , it constituted 36.0% and 39.5% from the newly diagnosed cancer cases in kuwaiti and non - kuwaiti females , respectively .
excision of the primary tumor ( by mastectomy or breast conserving surgery ) and sentinel lymph node or axillary lymph node dissection are standard procedures for the treatment of most cases . surgical site infection ( ssi )
the development of ssi can lead to prolonged hospital stay with increased costs , poor cosmetic results , psychological trauma , and , occasionally , a delay in postoperative adjuvant therapies . to the best of our knowledge , no published studies reported ssi rate after breast cancer surgery in kuwait . hence , the present investigation was aiming to determine the ssi rate after breast cancer surgeries and the causative microorganisms as a step to improve the management and the outcome of such patients .
all patients undergoing breast surgery in kuwait cancer control center  which is a comprehensive cancer center devoted exclusively to the care of patients with cancer  as a treatment for breast cancer from january 2009 to december 2010 were prospectively followed for the development of ssi .
indirect prospective detection of ssi was used to identify patients with ssis [ 5 , 6 ] .
patients were followed up to 30 days after surgery if there was no implant and up to one year when there was an implant placed during the operation .
ssis were identified using centers for disease control and prevention / national healthcare safety network ( cdc / nhsn ) surveillance definition of health care - associated infections .
diagnosis was based on collecting information from patients medical records including reviewing of clinical data ( symptoms and signs ) , investigations ( laboratory , histopathology , radiological , etc . ) , microbiological culture and sensitivity results , and medication charts in addition to discussions with the treating surgeons [ 5 , 6 ] .  
infections were identified either during the original surgical admission , at readmission to the hospital , or during outpatient follow up of the surgical wound by reviewing of medical records of surgery clinic patients [ 5 , 6 ] .
ssi rate during the study period was calculated using the following formula : 
 ( 1)number  of  ssis  in  breast  cancer  surgery100number  of  breast  cancer  surgery .
the total number of operations performed for breast cancer during the study period was 438 .
females represented the majority of patients , 434 ( 99.1% ) , while males constituted only 4 ( 0.9% ) cases .
breast surgeries done were excision of the tumor either by breast conserving surgery or mastectomy accompanied with sentinel lymph node biopsy or axillary lymph node clearance .
two patients 2/10 ( 20% ) required secondary wound closure or incision and drainage of the wound in the operating room .
most of the ssis ( 8 cases , 80% ) were detected after patients discharge , during outpatient follow up of the surgical wound . out of them 5/8 ( 62.5% )
all patients with ssi except one ( 90% ) received systemic antibiotic therapy for management of their wound infection .
staphylococcus aureus ( s. aureus ) was the most common pathogen ( isolated from 40% of all cases ) .
details of microbiological results were reported in table 1 . the majority ( 6/8 ( 75% ) ) of empirical therapy
it was reported that around 75% of breast cancer cases had undergone surgery as a part of their treatment . however , any surgical procedure has the potential risk of infection .
the potential morbidity caused by infection can lead to serious complications . delaying postoperative radiotherapy results in poorer control of local diseases .
a significant increase in metastatic relapse and reduced survival exist when adjuvant chemotherapy is delayed .
( 2.7% ) , 4.5% by leinung et al .   by olsen et al .
most of ssis were diagnosed after patients ' discharges . with the current trends favoring a shortened postoperative hospital stay
, it becomes more likely that a significant percentage of surgical site infections will occur after these patients ' discharges .
other investigators reported that an estimated 47% to 84% of ssis occur after discharge ; most of these are managed entirely in the outpatient setting [ 13 , 14 ] .
minor infections are usually managed on outpatient basis while complicated wounds require readmission with the possibility of surgical interference .
this is usually accompanied by delay in wound healing and consecutively delays of the start of postoperative adjuvant therapy .
most of our patients who developed ssi were readmitted for management of their complicated infections ( including reoperation ) adding extra cost on the healthcare settings and may worsen the patient outcome .
we believe that the rate of ssi in our study may be higher than we reported .
as the postoperative length of stay is decreasing , the follow up of the patient is mainly carried out on an outpatient basis . during outpatient visits ,
when the ssi develops and requires no readmission , surgeons may not document the infection in the patient 's records and may not request microbiological sampling of the wound .
this is primarily due to fear of medical malpractice claims or negligence especially in a surgery classified as a 
one like breast surgery . in the present investigation , despite the fact that s. aureus ( mssa and mrsa ) was the primary pathogen isolated from ssis , gram negative bacteria were isolated in 40% of cases representing a significant finding .
however , mukhtar et al .   reported gram negative bacteria as the most common isolated pathogens .
these findings support the importance of the use of empirical broad - spectrum antimicrobial ( not only targeting s. aureus ) coverage ( if any ) until culture results become available .
 
 background and objectives . surgical site infection ( ssi ) is the most common postoperative complication associated with breast cancer surgery . 
 the present investigation aimed to determine the ssi rate after breast cancer surgeries and the causative microorganisms . 
 patients and methods . 
 all patients who underwent breast surgery in kuwait cancer control center as a treatment for breast cancer from january 2009december 2010 were prospectively followed for the development of ssi . 
 indirect detection was used to identify ssis through medical record to review and discussion with the treating surgeons . 
 results . 
 the number of operations was 438 . 
 females represented 434 ( 99.1% ) cases while males constituted only 4 ( 0.9% ) cases . 
 ssis were diagnosed after 10 operations , all for female cases . 
 most of the ssis ( 8 cases ; 80% ) were detected after patients were discharged , during outpatient followup . 
 out of those 5/8 ; ( 62.5% ) were readmitted for management of ssi . 
 nine patients ( 90% ) received systemic antibiotic therapy for management of their wound infection . 
 the ssi rate was 2.3% . 
 the main causative organism was staphylococcus aureus ( s. aureus ) which was responsible for 40% of infections . 
 gram negative bacteria were isolated from 40% of the cases . 
 conclusion . 
 ssi is an important complication following breast cancer surgery . 
 microbiological diagnosis is an essential tool for proper management of such patients . 