The occurrence of bacteraemia with skin surgery

Abstract

The need for chemoprophylaxis for bacterial endocarditis is partly dependent on the risk of bacteraemia associated with the procedure, which has not been adequately defined for skin surgery. The incidence of postoperative bacteraemia in 149 immunocompetent out-patients with non-infected lesions was 0.7% (95% CI 0.3-3.8%). Procedures included excisions, flaps, grafts and micrographically controlled surgery. Coagulase-negative staphylococcus was the most common skin isolate at the site of surgery, present in 68.5% of patients. The most effective chemoprophylaxis would be intravenous vancomycin, which is inconvenient and has an inherent risk of morbidity. Given the low incidence of bacteraemia and the disadvantages of the optimum chemoprophylaxis, surgery on non-infected lesions does not warrant prophylactic antibiotics to prevent the very low risk of bacterial endocarditis.

Update on the Use of Antibiotics in Cutaneous Surgery

“…In multiple studies of patients undergoing dermatologic surgical procedures, bacteremia rates averaged 3%, which is similar to the 2.1% spontaneous rate of healthy adults 135–139. In the AHA recommendations, a bacteremia incidence of greater than 10% was considered relevant for procedures deemed to be higher risk 26,129,134.…”

“…The incidence of bacteremia after invasive dental procedures is in the range of 60 to 90% 140. As stated previously, the incidence of bacteremia after skin surgery is approximately 3%, equivalent to spontaneous bacteremia rates in healthy adults 135–139. Given these data, it would be reasonable to conclude that antibiotic prophylaxis is not warranted for patients whose joint replacement was more than 2 years previously and for whom no other high‐risk criteria exist.…”

Antibiotic Prophylaxis in Dermatologic Surgery: Updated Guidelines

“…The AHA guidelines address in detail only the prevention of endocarditis 5 . Its occurrence (including infective endocarditis and prosthetic valve endocarditis) after dermatologic surgery is a rare but serious complication 7,8,9,10,11,12 . Most reported cases of endocarditis are not attributable to invasive procedures, including medical, surgical, or dental procedures 5,13 .…”

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

“…In several studies, while not specifically addressing the risk of surgery in patients with damaged or artificial body parts, the incidence of bacteremia after surgical manipulation of intact skin remains low and thus does not warrant antibiotic prophylaxis even in high‐risk patients 3,4 . In another general bacteremia study, Carmichael et al 5 found the incidence of bacteremia during various dermatologic procedures to be 0.7%, within the range (0–2.1%) of random positive blood cultures found in healthy volunteers 6 . Generally infection after Mohs and dermatologic excisions has been noted to be 2.29%, with Mohs procedures on the ears as well as large postsurgical defects having a higher rate of wound infections 7 .…”