Prophylactic antibiotics and Postoperative Surgical Site Infections in cutaneous surgery: A systematic review and meta-analysis

Abstract

Introduction The risks and benefits of antibiotic prophylaxis (AP) in the setting of dermatologic surgery are unclear. This meta-analysis evaluated the effect of AP on the risk of SSIs and adverse events (AE) of AP in clean and clean/contaminated cutaneous surgical procedures. Methods Embase, MEDLINE, and Scopus databases were searched from inception through August 16, 2021. Two reviewers independently selected randomized controlled trials (RCTs) in which participants undergoing elective clean and clean/contaminated surgical procedures received either an identified course of AP, or no AP or a placebo. Data extracted were surgery type, antibiotic and control interventions, occurrence of SSIs and adverse events (AEs). SSI risk was pooled across trials by using a random-effects model. Certainty of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation approach. Results Twenty-eight RCTs (12,958 surgical wounds in 12,698 participants) were included. Postoperative SSIs were reduced in the AP group compared with controls (3.4% vs 7.4%; incidence rate ratio [IRR], 0.48 [95% CI, 0.37–0.62]; high certainty of evidence). Subgroup analysis showed a reduction in SSI risk for Mohs micrographic surgery (IRR, 0.22 [95% CI, 0.09–0.51]), dermatologic surgery (IRR, 0.29 [95% CI, 0.14–0.60]), and plastic or breast surgery (IRR, 0.60 [95% CI, 0.45–0.80]). Risk of AEs was not different between AP and control groups. Conclusion AP reduces SSI risk in clean and clean/contaminated cutaneous surgical procedures. The benefits of AP should be balanced against costs, drug interactions, antibiotic resistance, and surgical sites or procedures that are associated with a lower likelihood of infection. Highlights