Association of Postoperative Antibiotics With Surgical Site Infection in Mohs Micrographic Surgery

Levin, Ethan; Chow, CB; Makhzoumi, Zaineb; Jin, Chengshi; Shiboski, Stephen; Arron, Sarah T.

doi:10.1097/dss.0000000000001645

Cited by 32 publications

(18 citation statements)

References 17 publications

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“…The reported rates of SSI after MMS in the dermatologic literature range from 0.7% to 3.4%, even in the absence of postoperative antibiotics. 9,12,13,19 Although infections are higher in immunosuppressed patients, a recent large review still only demonstrated a postoperative SSI rate of 2.5% in their immunosuppressed patients. 20 We performed this study to evaluate our hypothesis that postoperative antibiotics are not associated with a decreased risk of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Although the overall use of antibiotics in dermatology has decreased from 2008 to 2016, the prescribing of antibiotics for MMS has increased from 9.9% to 13.8% during this same period 8 . The reason most often given for prescribing antibiotics in MMS surgery is the surgeon's routine practice; these are typically not evidence‐based decisions 9 . The last American Academy of Dermatology Position Statement on antibiotics in MMS does not provide a strong guideline for whether to provide antibiotics to the typical patient undergoing MMS 10 .…”

Section: Introductionmentioning

confidence: 99%

“…8 The reason most often given for prescribing antibiotics in MMS surgery is the surgeon's routine practice; these are typically not evidence-based decisions. 9 The last American Academy of Dermatology Position Statement on antibiotics in MMS does not provide a strong guideline for whether to provide antibiotics to the typical patient undergoing MMS. 10 Hence, a lot is left open to surgeon interpretation of the literature and/or his or her personal experience.…”

Section: Introductionmentioning

confidence: 99%

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Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

et al. 2020

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Objectives/Hypothesis The prescribing of postoperative antibiotics for patients undergoing Mohs reconstructive surgery has increased in the last decade, while antibiotic resistance has been increasing. We hypothesized that routine prescribing of postoperative antibiotics after Mohs reconstruction does not decrease the risk of surgical site infection. Study Design Retrospective, single‐institution cohort study. Methods This study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 29, 2019. The main outcomes assessed included postoperative surgical site infections, partial or full flap/graft necrosis, hematoma, and dehiscence. Results A total of 900 defects in 800 patients (mean age [range] = 65.3 [21–96], 54.60% female) were identified over the 7‐year period. Patient‐specific variables reviewed included comorbidities, age, and smoking status. Surgery‐specific variables analyzed included defect characteristics, time interval between Mohs micrographic surgery and reconstruction, reconstructive modalities, and use of postoperative antibiotics. All patients received peri‐incisional antibiotics. On regression analysis, use of cartilage grafts (odds ratio [OR]: 6.53; 95% CI: 2.1‐20.6; P = .001), current smoking status (OR: 6.67; 95% CI: 2.09‐21.30; P = .001), full‐thickness defects (OR: 1.2; 95% CI: 1.0‐3.4; P = .045), and interpolated flap reconstruction (OR: 3.4; 95% CI: 1.0‐11.5; P = .049) were associated with an increased risk of postoperative infections. Smoking and cartilage grafting remained significant on bivariable regression modeling. Use of perioperative antibiotics was not associated with a decreased risk of infection (OR: 1.82; 95% CI: 0.23‐14.21; P = .568). Conclusions We found no association between postoperative infections after Mohs reconstructive surgery and the use of postoperative antibiotics. These data support a more targeted approach to antibiotic prescribing in Mohs reconstructive surgery. Level of Evidence 4 Laryngoscope, 131:E434–E439, 2021

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

et al. 2020

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“…Multiple studies have reported low infection rates for patients undergoing MMS, with the largest study by Alam et al reporting an overall infection complication rate of 0.4% 13 . Infection rates remain below the 3% to 5% acceptable range even when antibiotic prophylaxis is not employed or used strictly according to AHA guidelines 9,40‐42 . According to a 2008 advisory statement on antibiotic prophylaxis for cutaneous surgery: “For patients with high‐risk cardiac conditions, and a defined group of patients with prosthetic joints at high risk for hematogenous total joint infection, prophylactic antibiotics are recommended when the surgical site is infected or when the procedure involves breach of the oral mucosa.…”

Section: Surgical Site Infectionmentioning

confidence: 99%

Complications of cutaneous surgery

Rothstein

Cohen²

2020

Dermatological Reviews

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Background Cutaneous surgery is associated with multiple complications including hemorrhage, surgical site infection, necrosis, and scarring. As demand for dermatologic surgery rises, it is imperative that dermatologists have a comprehensive understanding of the potential surgical risks to enhance patient safety and outcomes. Aims The purpose of this review is to highlight the rates, prevention, and management of common complications associated with cutaneous surgery, with a focus on scalpel‐based surgeries including Mohs micrographic surgery and standard surgical excision. Material and Methods Articles from PubMed are highlighted and our clinical experience is presented. Results Cutaneous surgery is overall safe and associated with low rates of complications that are predominantly minor and not life‐threatening. Prevention and management strategies vary according to the specific complication being addressed. Discussion Dermatologists should be familiar with the complications of cutaneous surgery. As our knowledge of surgical complications expands, the outcomes of our patients will continue to improve.

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“…Несмотря на то, что ИОХВ с формальной точки зрения являются нозокомиальными, т. е. развиваются обычно спустя 30 дней после проведения соответствующего хирургического вмешательства, роль качественного и количественного состава микробиома кожи как одного из важнейших этиологических факторов была неоднократно продемонстрирована в нескольких клинических исследованиях [4]. Наиболее частым из возможных способов профилактики импетигинизации послеоперационной раны, т. е. развития поверхностной ИОХВ, в раннем послеоперационном периоде является применение топических антибактериальных и антисептических средств [6,7]. Одним из таких антибактериальных средств является топический комбинированный препарат, содержащий бацитрацин и неомицин.…”

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