The Effect of Antibiotic Prophylaxis on Infection Rates in Mohs Micrographic Surgery: A Single-institution Retrospective Study

BACKGROUND: Data and recommendations regarding antibiotic prophylaxis in dermatologic surgery vary in terms of effectiveness in preventing surgical site infection, prosthetic joint infection, infective endocarditis, and specifics regarding administration.

OBJECTIVE: The objective of this study is to describe the effect of antibiotic prophylaxis (AP) in Mohs micrographic surgery (MMS) on infective endocarditis, prosthetic joint infection, and surgical site infection.

METHODS: A single-institution retrospective cohort study of antibiotic use (pre-/intra-operative, post-operative or none) among 2,364 patient encounters treated with MMS was performed. Information regarding patient demographics, surgical site infection, prophylactic antibiotic administration (e.g. none, pre-/intraoperative loading dose, postoperative), type of repair, tumor type, surgery site, duration of patient stay, and other relevant covariates were collected. Inclusion criteria also included those who had at last one follow-up appointment or phone call with any provider after surgery. Bivariate logistic regression evaluated for associations between patient and operative characteristics, antibiotic use, and infectious complications.

RESULTS: 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.

CONCLUSION: 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 joints.