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Clinical Characteristics of Gram-Negative Surgical Site Infections in Patients Treated With Mohs Micrographic
Alexander Hicks1, Anika Mazumder2, Rylee Moody3
1Skin and Allergy Center, Spring Hill, TN.
Background:
Surgical site infections (SSIs) are the most common adverse events after Mohs micrographic surgery (MMS). However, there is a paucity of literature characterizing gram-negative (GN) SSIs after MMS.
Objective:
This study aimed to depict the clinical features and risk factors of GN infections after MMS.
Materials And Methods:
A retrospective review was performed from all postoperative wound cultures after MMS from 2017 to 2021 at Saint Louis University Medical Center. Patient demographics, surgical details, and wound clinical characteristics at follow-up appointments were reviewed.
Results:
Six hundred and seventy-six wound cultures were eligible with 15.1% yielding GN infection. Gram-negative SSIs had significantly lower rates of severe erythema and purulence compared with gram-positive (GP) SSIs, and only had significantly more edema compared with culture-negative wounds ( p < .05). Although not significant, there was a trend for GN SSIs to have higher rates of pain compared with culture-negative wounds ( p = .075).
Conclusion:
Gram-negative SSIs after MMS may present with more subtle clinical features, especially compared with typical GP infections. Having a low threshold for obtaining wound culture for edematous or painful postoperative wounds may aid in detecting potentially overlooked GN infections.
Insights
Gram-negative surgical site infections (SSIs) after Mohs micrographic surgery (MMS) often present subtly. Early wound culture is recommended for edematous or painful postoperative wounds to detect these infections.
Area of Science:
- Dermatology
- Infectious Diseases
- Surgical Oncology
Background:
- Surgical site infections (SSIs) are common complications following Mohs micrographic surgery (MMS).
- Limited research exists on the specific characteristics of gram-negative (GN) SSIs after MMS.
- Understanding GN SSIs is crucial for effective patient management post-MMS.
Purpose of the Study:
- To characterize the clinical presentation of gram-negative (GN) infections after Mohs micrographic surgery (MMS).
- To identify potential risk factors associated with GN SSIs following MMS.
Main Methods:
- Retrospective review of postoperative wound cultures from MMS procedures between 2017 and 2021.
- Analysis of patient demographics, surgical details, and wound characteristics.
- Comparison of GN SSIs with gram-positive (GP) SSIs and culture-negative wounds.
Main Results:
- 15.1% of eligible wound cultures after MMS yielded GN infections.
- GN SSIs showed less severe erythema and purulence compared to GP SSIs.
- Edema was significantly more prevalent in GN SSIs compared to culture-negative wounds.
Conclusions:
- Gram-negative SSIs following MMS may exhibit less obvious clinical signs than gram-positive infections.
- A lower threshold for wound culturing in cases of postoperative edema or pain is advised.
- Prompt identification of GN SSIs can prevent delayed or missed diagnoses.
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