The effect of antibiotic prophylaxis on infection rates in mohs micrographic surgery: a single-institution retrospective
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ORIGINAL PAPER
The effect of antibiotic prophylaxis on infection rates in mohs micrographic surgery: a single‑institution retrospective study Oliver Taylor1 · Jeffrey Niu Li1 · Christian Carr1 · Antonio Garcia1 · Sophia Tran1 · Divya Srivastava1 · Rajiv I. Nijhawan1 Received: 23 July 2020 / Revised: 14 September 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract As data and recommendations regarding antibiotic prophylaxis in dermatologic surgery vary, we tried to describe the effect of antibiotic prophylaxis (AP) in Mohs micrographic surgery (MMS) on infective endocarditis, prosthetic joint infection, and surgical site infection using a single-institution retrospective cohort study of antibiotic use (pre-/intra-operative, postoperative or none) among 2,364 patient encouters treated with MMS. Bivariate logistic regression was evaluated for associations between patient and operative characteristics, antibiotic use, and infectious complications. 85.8% of patients received no AP, 10.0% received post-operative AP, and 4.1% received pre-/intra-operative AP. The overall surgical site infection (SSI) rate was 1.3%. SSI did not differ between patients who received pre-/intra-operative prophylaxis, post-operative prophylaxis or no antibiotics. One patient receiving pre-/intra-operative prophylaxis developed SSI. Repairs involving porcine xenografts and interpolation/pedicle flaps were associated with increased SSI. In addition, there were no patients who post-operatively experienced an infected joint or infective endocarditis. Limitations include selection bias, use of observational retrospective data, low infection rates, single institution analysis, and possible omission of explanatory variables or confounders. There was no difference in rates of SSI when comparing MMS patients who received pre-/intra-operative, post-operative or no AP. There were no cases of infective endocarditis or infected prosthetic joint. Keywords Dermatologic surgery · Antibiotic · Infection · Mohs micrographic surgery · Prophylaxis
Introduction Mohs Micrographic Surgery (MMS) is a safe office-based procedure with low rates of adverse events, with the most common complication being surgical site infection (SSI) [1, 2]. While prevention of SSI, infective endocarditis (IE), and prosthetic joint infection (PJI) are the main reasons for antibiotic prophylaxis (AP) in dermatologic surgery, AP for
Oliver Taylor and Jeffrey Li contributed equally as first authors for this manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00403-020-02153-3) contains supplementary material, which is available to authorized users. * Rajiv I. Nijhawan [email protected] 1
Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, 4th Floor, Suite 100, Dallas 75390, USA
any reason remains controversial mostly due to a paucity of large-scale randomized controlled trials. There is limited evidence that AP
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