Antibiotic Prophylaxis of Surgical Site Infections in Cutaneous Surgery: A Prospective Observational Study

Authors

  • Benjamin Kendziora Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany https://orcid.org/0000-0002-5234-5380
  • Kathrin Patzer Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
  • Lars E. French Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, German; Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, USA
  • Justin G. Schlager Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
  • Daniela Hartmann Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany

DOI:

https://doi.org/10.2340/actadv.v103.4469

Keywords:

surgical wound infection, antibiotic prophylaxis, observational study, propensity score

Abstract

The use of perioperative antibiotic prophylaxis in cutaneous surgery is controversial due to unclear efficacy and, thus, potentially unnecessary side-effects. This prospective observational study analysed the efficacy of oral perioperative antibiotic prophylaxis in preventing surgical site infections. Adult patients undergoing cutaneous surgery between August 2020 and May 2021 at Ludwig-Maximilian University Hospital Munich, Germany, without prior signs of infection were eligible. Propensity score weighting was used for covariate adjustment to account for non-randomized treatment assignment. Of 758 included patients, 23 received perioperative antibiotic prophylaxis (3.0%). In this group, a surgical site infection occurred in 1 of 45 lesions (2.2%) compared with 76 of 1,189 lesions (6.5%) in the group without perioperative antibiotic prophylaxis (735 patients, 97.0%). With covariate adjustment, the odds ratio for the occurrence of a surgical site infection in patients receiving perioperative antibiotic prophylaxis was 0.114 (95% confidence interval 0.073–0.182; p <0.001) on a per lesion level. The number of lesions needed to treat to prevent 1 surgical site infection was 17.6 (95% confidence interval 16.8–19.2). This prospective observational study shows a reduction in the incidence of surgical site infection in cutaneous surgery performed with perioperative antibiotic prophylaxis. The large size difference between the 2 study groups limits the study.

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References

Harlan CA, Nguyen NB, Hirshburg JM, Hirshburg JM. Updates on recommendations for prophylactic antibiotics in dermatologic surgery. Dermatol Surg 2021; 47: 298-300.

https://doi.org/10.1097/DSS.0000000000002315 DOI: https://doi.org/10.1097/DSS.0000000000002315

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135: e1159-e1195.

https://doi.org/10.1161/CIR.0000000000000503 DOI: https://doi.org/10.1161/CIR.0000000000000503

Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075-3128.

https://doi.org/10.1093/eurheartj/ehv319

Sollecito TP, Abt E, Lockhart PB, Truelove E, Paumier TM, Tracy SL, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners - a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2015; 146: 11-16.e18.

https://doi.org/10.1016/j.adaj.2014.11.012 DOI: https://doi.org/10.1016/j.adaj.2014.11.012

Watters W, 3rd, Rethman MP, Hanson NB, Abt E, Anderson PA, Carroll KC, et al. Prevention of orthopaedic implant infection in patients undergoing dental procedures. J Am Acad Orthop Surg 2013; 21: 180-189.

https://doi.org/10.5435/JAAOS-21-03-180 DOI: https://doi.org/10.5435/JAAOS-21-03-180

Johnson-Jahangir H, Agrawal N. Perioperative antibiotic use in cutaneous surgery. Dermatol Clin 2019; 37: 329-340.

https://doi.org/10.1016/j.det.2019.03.003 DOI: https://doi.org/10.1016/j.det.2019.03.003

Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075-3128.

https://doi.org/10.1093/eurheartj/ehv319 DOI: https://doi.org/10.1093/eurheartj/ehv319

European Centre for Disease Prevention and Control (ECDC). Surveillance of surgical site infections and prevention indicators in European hospitals - HAI-Net SSI protocol, version 2.2. Stockholm: ECDC; 2017.

Kuss O, Blettner M, Börgermann J. Propensity score: an alternative method of analyzing treatment effects. Dtsch Arztebl Int 2016; 113: 597-603.

https://doi.org/10.3238/arztebl.2016.0597 DOI: https://doi.org/10.3238/arztebl.2016.0597

Samuel DP, Lindsay CP, Matthew L, Luke K. Optimal multilevel matching using network flows: an application to a summer reading intervention. Ann Appl Statist 2018; 12: 1479-1505.

https://doi.org/10.1214/17-AOAS1118 DOI: https://doi.org/10.1214/17-AOAS1118

van Duin D, Paterson DL. Multidrug-resistant bacteria in the community: an update. Infect Dis Clin North Am 2020; 34: 709-722.

https://doi.org/10.1016/j.idc.2020.08.002 DOI: https://doi.org/10.1016/j.idc.2020.08.002

Schlager JG, Hartmann D, Ruiz San Jose V, Patzer K, French LE, Kendziora B. Procedure-related risk factors for surgical site infection in dermatologic surgery. Dermatol Surg 2022; 48: 1046-1050.

https://doi.org/10.1097/DSS.0000000000003546 DOI: https://doi.org/10.1097/DSS.0000000000003546

Schlager JG, Hartmann D, Wallmichrath J, Ruiz San Jose V, Patzer K, French LE, et al. Patient-dependent risk factors for wound infection after skin surgery: a systematic review and meta-analysis. Int Wound J 2022; 19: 1748-1757.

https://doi.org/10.1111/iwj.13780 DOI: https://doi.org/10.1111/iwj.13780

Schlager JG, Ruiz San Jose V, Patzer K, French LE, Kendziora B, Hartmann D. Are specific body sites prone for wound infection after skin surgery? A systematic review and meta-analysis. Dermatol Surg 2022; 48: 406-410.

https://doi.org/10.1097/DSS.0000000000003387 DOI: https://doi.org/10.1097/DSS.0000000000003387

Boonchan T, Wilasrusmee C, McEvoy M, Attia J, Thakkinstian A. Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery. Br J Surg 2017; 104: e106-e117.

https://doi.org/10.1002/bjs.10441 DOI: https://doi.org/10.1002/bjs.10441

Kasatpibal N, Nørgaard M, Sørensen HT, Schønheyder HC, Jamulitrat S, Chongsuvivatwong V. Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand. BMC Infect Dis 2006; 6: 111.

https://doi.org/10.1186/1471-2334-6-111 DOI: https://doi.org/10.1186/1471-2334-6-111

Liang B, Dai M, Zou Z. Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy: a systematic review and meta-analysis. J Gastroenterol Hepatol 2016; 31: 921-928.

https://doi.org/10.1111/jgh.13246 DOI: https://doi.org/10.1111/jgh.13246

Mazaki T, Mado K, Masuda H, Shiono M. Antibiotic prophylaxis for the prevention of surgical site infection after tension-free hernia repair: a Bayesian and frequentist meta-analysis. J Am Coll Surg 2013; 217: 788-801.e781-784.

https://doi.org/10.1016/j.jamcollsurg.2013.07.386 DOI: https://doi.org/10.1016/j.jamcollsurg.2013.07.386

Uchino M, Ikeuchi H, Bando T, Chohno T, Sasaki H, Horio Y, et al. Efficacy of preoperative oral antibiotic prophylaxis for the prevention of surgical site infections in patients with Crohn disease: a randomized controlled trial. Ann Surg 2019; 269: 420-426.

https://doi.org/10.1097/SLA.0000000000002567 DOI: https://doi.org/10.1097/SLA.0000000000002567

Li K, Sambare TD, Jiang SY, Shearer EJ, Douglass NP, Kamal RN. Effectiveness of preoperative antibiotics in preventing surgical site infection after common soft tissue procedures of the hand. Clin Orthop Relat Res 2018; 476: 664-673.

https://doi.org/10.1007/s11999.0000000000000073 DOI: https://doi.org/10.1007/s11999.0000000000000073

Zhang Y, Dong J, Qiao Y, He J, Wang T, Ma S. Efficacy and safety profile of antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery: a meta-analysis of randomized controlled trials. Ann Plast Surg 2014; 72: 121-130.

https://doi.org/10.1097/01.SAP.0000440955.93769.8c DOI: https://doi.org/10.1097/01.SAP.0000440955.93769.8c

Warnock M, Ogonda L, Yew P, McIlvenny G. Antibiotic prophylaxis protocols and surgical site infection rates in trauma surgery: a prospective regional study of 26,849 procedures. Ulster Med J 2019; 88: 111-114.

Farmer N, Hodgetts-Morton V, Morris RK. Are prophylactic adjunctive macrolides efficacious against caesarean section surgical site infection: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 244: 163-171.

https://doi.org/10.1016/j.ejogrb.2019.11.026 DOI: https://doi.org/10.1016/j.ejogrb.2019.11.026

Platt R, Zucker JR, Zaleznik DF, Hopkins CC, Dellinger EP, Karchmer AW, et al. Perioperative antibiotic prophylaxis and wound infection following breast surgery. J Antimicrob Chemother 1993; 31 Suppl B: 43-48.

https://doi.org/10.1093/jac/31.suppl_B.43 DOI: https://doi.org/10.1093/jac/31.suppl_B.43

Rosengren H, Heal CF, Buttner PG. Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial. BMJ Open 2018; 8: e020213.

https://doi.org/10.1136/bmjopen-2017-020213 DOI: https://doi.org/10.1136/bmjopen-2017-020213

Smith SC, Heal CF, Buttner PG. Prevention of surgical site infection in lower limb skin lesion excisions with single dose oral antibiotic prophylaxis: a prospective randomised placebo-controlled double-blind trial. BMJ Open 2014; 4: e005270.

https://doi.org/10.1136/bmjopen-2014-005270 DOI: https://doi.org/10.1136/bmjopen-2014-005270

Bari O, Eilers RE, Jr, Rubin AG, Jiang SIB. Clinical characteristics of lower extremity surgical site infections in dermatologic surgery based upon 24-month retrospective review. J Drugs Dermatol 2018; 17: 766-771.

Additional Files

Published

2023-05-10

How to Cite

Kendziora, B., Patzer, K., French, L. E., Schlager, J. G., & Hartmann, D. (2023). Antibiotic Prophylaxis of Surgical Site Infections in Cutaneous Surgery: A Prospective Observational Study. Acta Dermato-Venereologica, 103, adv4469. https://doi.org/10.2340/actadv.v103.4469