The role of preoperative antibiotic prophylaxis in cosmetic surgery

An estimated 2.7 million cosmetic procedures were performed in the United States in 1998, yet the role of preoperative antibiotic prophylaxis for cosmetic surgery is not clearly defined. Routine antibiotic prophylaxis for cosmetic procedures was discontinued by the senior author at the authors' institution in an effort to reduce use and cost in June of 1999. Subsequently, a cluster of four Staphylococcus aureus postoperative surgical site infections were identified. A case-control study to identify risk factors for surgical site infections in these patients was performed. All patients who underwent cosmetic surgical procedures by the senior author during June of 1999 and did not develop a surgical site infection were selected as control patients. Four case patients and 12 control patients were included in the study. The significant risk factors associated with surgical site infections were the mean duration of procedure (5 hours versus 2 hours; p = 0.02), general anesthesia (p = 0.004), and placement of a Blake drain (p = 0.004). No common source of infection was identified by review and observation of surgical technique. Pulse-field gel analysis of the S. aureus isolates from the four case patients and the nares of surgical personnel revealed no common strain. After the reinstitution of preoperative antibiotic prophylaxis with cefazolin for procedures anticipated to last 3 hours or longer, no additional surgical site infections were identified through December of 1999 (four of 29 versus none of 104; p = 0.002). It was concluded that targeted antibiotic prophylaxis for cosmetic surgery with cefazolin may be useful in reducing surgical site infections attributable to S. aureus.