Antibiotic Prophylaxis Guideline Awareness and Antibiotic Prophylaxis Use Among New York State Dermatologic Surgeons

Abstract

Dermatologic surgeons commonly use antibiotic prophylaxis to prevent bacterial endocarditis. Based on previous studies, though, the risk of endocarditis following cutaneous surgery is low and thus the use of antibiotic prophylaxis is controversial. Although this practice is appropriate for high-risk patients when skin is contaminated, it is not recommended for noneroded, noninfected skin. We report that dermatologists may be aware of the guidelines, but only seem to partially follow them. Further studies are still needed to establish optimal guidelines.

Antibacterial Prophylaxis in Dermatologic Surgery

“…[33,34] The need for prophylactic antibacterials depends on the wound classification. [1,3,6,20,33,34] Class I wounds (primary closure of wounds on clean, non-contaminated skin under sterile conditions) should generally not receive antibacterial prophylaxis. Only immunocompromised patients with class II wounds (involving oral and nasal mucosa or the axillary and anogenital areas) should receive antibacterial prophylaxis.…”

“…[1][2][3][4] Despite this, medical practitioners vary greatly in their use of antibacterial prophylaxis and frequently overprescribe antibacterials for the prevention of SSI, bacterial endocarditis, and prosthesis infection. [6][7][8][9] Though the overall risk of SSI in dermatologic surgery is low, studies have shown that some dermatologic surgical sites and reconstructive procedures are associated with infection rates that may be unacceptably high. This article discusses those studies and considers the use of antibacterial prophylaxis for higher risk dermatologic sites and surgical procedures.…”

Update on the Use of Antibiotics in Cutaneous Surgery

“…Dicloxacillin is well known in the dermatology community for its excellent gram‐positive coverage, specifically S. aureus , and is used by many for endocarditis prophylaxis 9,10,12. This is based on studies showing frequent colonization of eroded skin lesions by S. aureus and vague recommendations by the AHA for procedures not specifically discussed in their guidelines to use an antibiotic with coverage of organisms most likely to cause endocarditis that are suspected of colonizing the area in which surgery is to be performed 26,129.…”

“…With regard to dermatologic surgery, the data for or against antibiotic therapy are often limited. Nonetheless, some guidelines do exist, and recent surveys have shown that dermatologists often use such agents inappropriately 9–11. The purpose of this article is to review the literature regarding the use of topical and systemic antibiotics prophylactically, intraoperatively, and post‐operatively.…”

Prospective evaluation of surgical site infection rate among patients with Mohs micrographic surgery without the use of prophylactic antibiotics

“…Other surgeons opt to place patients undergoing MMS with certain types of closures or in certain locations on antibiotic prophylaxis routinely without solid evidence to support surgical site infection such practices. 1,2,4,5,[25][26][27][28] These practices may increase patient exposure to potential adverse events and increase antibiotic resistance.…”