Antibiotic Use and Surgical Site Infections in Immunocompromised Patients After Mohs Micrographic Surgery: A
Tuyet A Nguyen1,2, Georgina Rowe1,3, Kristin Harris1
1Department of Dermatology, Cedars-Sinai Medical Center, Beverly Hills, California.
Background:
As Mohs micrographic surgery becomes more widely used in immunosuppressed patients, it is important to understand the risks in this unique population.
Objective:
To determine whether immunosuppressed patients are at an increased risk for surgical site infection and evaluate the utility of postoperative antibiotics for the prevention of surgical site infection.
Materials And Methods:
A single-center retrospective review of patients who underwent Mohs micrographic surgery between October 9, 2014, and August 20, 2021, was performed.
Results:
Five thousand eight hundred eighty-six independent cases were identified. Factors associated with an increased incidence of antibiotic use included preoperative lesion size >40 mm (86.7%, n = 13; p < .01) and high-risk lesion location (46.4%, n = 1,268; p < .01). Patients were not more likely to be prescribed antibiotics if immunosuppressed (37.0%, n = 269 vs 34.2%, n = 1765; p = .14), and immunosuppression was not independently associated with antibiotic use on multivariate analysis (odds ratio 1.2, 95% confidence interval 1.0-1.5). Infection rates were similar between immunocompromised patients and immunocompetent patients (2.1%, n = 15 vs 1.6%, n = 80, respectively; p = .30). In immunosuppressed patients, antibiotic use did not decrease the likelihood of infection (3.0%, n = 8 vs 1.5%, n = 7; p = .19).
Conclusion:
There was no association between immunosuppression and surgical infection rate. Furthermore, postoperative antibiotics should not be indicated in these patients unless other high-risk criteria exist.
Insights
Immunosuppressed patients undergoing Mohs surgery do not face a higher risk of surgical site infection. Postoperative antibiotics are not recommended for this group unless other high-risk factors are present.
Area of Science:
- Dermatology
- Surgical Oncology
- Infectious Disease
Background:
- Mohs micrographic surgery is increasingly performed on immunosuppressed patients.
- Understanding surgical site infection (SSI) risks in this population is crucial.
Purpose of the Study:
- To assess if immunosuppressed patients have a higher risk of SSI after Mohs surgery.
- To evaluate the effectiveness of postoperative antibiotics in preventing SSIs in this cohort.
Main Methods:
- Retrospective review of 5,886 Mohs micrographic surgery cases (October 2014 - August 2021).
- Analysis of factors associated with antibiotic use and SSI incidence.
- Comparison of infection rates between immunosuppressed and immunocompetent patients.
Main Results:
- No significant difference in SSI rates between immunosuppressed (2.1%) and immunocompetent (1.6%) patients.
- Immunosuppression was not independently associated with increased antibiotic use.
- Antibiotic use did not reduce infection likelihood in immunosuppressed patients.
Conclusions:
- No association found between immunosuppression and surgical infection rates after Mohs surgery.
- Routine postoperative antibiotics are not indicated for immunosuppressed patients undergoing Mohs surgery unless other high-risk criteria are met.
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