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.

Bacteriological studies of blood, tissue fluid, lymph and lymph nodes in patients with acute dermatolymphangioadenitis (DLA) in course of ‘filarial’ lymphedema

“…This applies to S. epidermidis which can cause sepsis and shock (Zierdt, 1983;Hedin, 1993;Burchard et al, 1984). Coagulase-negative Staphylococci and Bacterioides can be a cause of bacteriemia during skin surgery (Carmichael et al, 1993). The Bacilli are significant residents of skin depending on individual differences in skin nutrients, microclimate, and inhibiting substances of host or resident flora origin (Bibel et al, 1978).…”

Antibiotic prophylaxis in dermatologic surgery: Advisory statement 2008

“…As with prophylaxis against infective endocarditis, this recommendation is based on the low incidence of intraoperative bacteremia during dermatologic surgery and is consistent with the movement away from antibiotic administration by the AHA. [1][2][3][4]18 However, in concordance with the AHA, we do recommend prophylactic antibiotics to prevent total joint prosthesis infection for dermatologic surgery when it involves perforation of oral mucosa, an infected site, or a noninfected site that is at high risk of surgical site infection. These recommendations are summarized in Table V.…”

“…[1][2][3][4] Pooled data from 4 studies on the risk of bacteremia during dermatologic surgery with scalpel excision, electrodesiccation and curettage, Mohs surgery, hair transplantation, flaps and grafts on clinically noninfected, eroded, or intact skin revealed a risk of bacteremia at 1.9% (5/265 subjects). [1][2][3][4] Of note, 3 of the 5 subjects with positive blood cultures grew organisms (Propionibacterium acnes and Staphylococcus hominis) not typically associated with native valve endocarditis and represent normal skin flora that frequently contaminates blood cultures. 4 This risk of bacteremia is lower than that reported in healthy patients with no known infection performing normal daily activities, 2.1%.…”

Incidence of Bacteremia, Infective Endocarditis, or Prosthetic Joint Infection in Dermatologic Surgery: A Systematic Review

“…Five articles were prospective cohort studies, in which blood cultures were drawn at the time of and during cutaneous surgery to determine incidence of bacteremia; 1 case series of IE after dermatologic procedures (cryosurgery, punch biopsy, acupuncture, and melanoma excision); 1 case report of endocarditis after punch biopsy; 1 prospective cohort of bacteremia incidence after incision and drainage of skin abscesses, a case-crossover study on invasive procedures associated with the development of IE; and a final case-control study of IE after minor procedures, including soft tissue surgery. [13][14][15][16][17][18][19][20] There were no reports found of PJI directly related to cutaneous surgery; however, there were several reports of Propionibacterium acnes infection of prosthetic joints and cardiac leads related to potential inadequate sterilization before these respective procedures (Table 1).…”

“…This patient developed bacteremia and IE 1 week after cryoremoval of a nevus on her back. She Carmichael and colleagues 18 The incidence of postoperative bacteremia in 149 immunocompetent patients with noninfected lesions was 0.7% The most commonly isolated pathogen was coagulase-negative staphylococcus (65.8% of patients)…”