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A Delayed Inoculation Model of Chronic Pseudomonas aeruginosa Wound Infection
Published on: February 20, 2020
Prospective study of wound infections in dermatologic surgery in the absence of prophylactic antibiotics
Anthony J Dixon1, Mary P Dixon, Deborah A Askew
1Skinalert Skin Cancer Clinics, Geelong, Australia. Anthony@skincanceronly.com
Objective:
The study aimed to identify wound sites/procedures where infection incidence was over 5%, such that these circumstances may warrant wound infection antibiotic prophylaxis.
Method:
We undertook a 3-year prospective study of 5,091 lesions (predominantly nonmelanoma skin cancer) treated on 2,424 patients from July 2002 to June 2005. No patient was given prophylactic antibiotics, and no patient ceased warfarin or aspirin.
Results:
Overall infection incidence was 1.47%. Individual procedures had the following infection incidence: curettage 0.73% (3/412); skin flap repairs 2.94% (47/1601); simple excision and closure 0.54% (16/2974); skin grafts 8.70% (6/69); and wedge excision 8.57% (3/35). Analysis of regions of the body demonstrated that surgery below the knee (n = 448) had an infection incidence of 6.92% (31/448) (p < .0001). Subanalysis demonstrated that all regions below the knee were at high infection risk. Elsewhere, groin excisional surgery had an infection incidence of 10% (1/10) (p = .027). No other body site demonstrated an infection incidence beyond 5% of statistical significance. Procedures on the face demonstrated an infection incidence of 0.81% (18/2,209). Diabetic patients, those on warfarin and/or aspirin, and smokers showed no difference in infection incidence.
Conclusion:
Based on a prediction of infection incidence over 5%, the following cutaneous oncologic procedures warrant consideration of oral antibiotic wound infection prophylaxis: all procedures below the knee, wedge excisions of lip and ear, all skin grafts, and lesions in the groin. Other than under these circumstances, surgery to the nose, ear, fingers, lips, skin flap surgery, and surgery on diabetics, smokers, and those on anticoagulants have previously been considered for wound infection prophylaxis but do not warrant such intervention based on our data. The authors have indicated no significant interest with commercial supporters.
Insights
Wound infection prophylaxis may be warranted for procedures below the knee, skin grafts, and groin excisions, as these sites show infection rates over 5%. Other common procedures and patient factors do not necessitate routine antibiotic use.
Area of Science:
- Dermatology
- Surgical Oncology
- Infectious Disease
Background:
- Surgical site infections (SSIs) are a concern in cutaneous oncologic procedures.
- Identifying specific high-risk procedures and patient populations is crucial for targeted antibiotic prophylaxis.
Purpose of the Study:
- To determine wound sites and procedures with an infection incidence exceeding 5%.
- To guide decisions regarding the use of antibiotic prophylaxis for wound infections.
Main Methods:
- A prospective study of 5,091 lesions from 2,424 patients treated between July 2002 and June 2005.
- Infection incidence was tracked for various procedures and body sites without prophylactic antibiotics or cessation of anticoagulants/antiplatelets.
Main Results:
- Overall infection incidence was 1.47%.
- High infection rates (>5%) were observed for procedures below the knee (6.92%), skin grafts (8.70%), wedge excisions (8.57%), and groin excisions (10%).
- No increased infection risk was found for diabetic patients, smokers, or those on anticoagulants/antiplatelets.
Conclusions:
- Procedures below the knee, skin grafts, wedge excisions (lip/ear), and groin excisions warrant consideration for antibiotic prophylaxis.
- Routine antibiotic prophylaxis is not supported by data for procedures on the face, nose, ear, fingers, lips, skin flaps, or for patients with specific risk factors like diabetes or anticoagulant use.