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Retrospective Review of the Infection Rate of Lower Extremities Treated With Mohs Micrographic Surgery With and
Jay R Patel1, Mariana Chrispim Gimenez2, Norhan Shamloul1
1Department of Dermatology, University of Rochester Medical Center, Rochester, New York.
Background:
Prophylactic antibiotic use in Mohs micrographic surgery (MMS) is guided by descriptive studies in the 2008 advisory statement recommending use for high-risk sites, including lower extremities due to a greater than 5% infection rate. Studies since 2008 have not identified decreases in infection with prophylactic antibiotics.
Objective:
To identify the impact of preoperative prophylactic antibiotics on lower extremity infection rate for patients undergoing MMS.
Methods:
A retrospective review was conducted at the University of Rochester Department of Dermatology from one surgeon (1/2019-6/2024). Adults undergoing MMS to below the knee were included. Patients from 2019 to 2021 had routine preoperative dose of 1 g oral cefadroxil. Patients from 2022 to 2024 did not receive preoperative antibiotics. Patient demographics, tumor type, surgery characteristics, reconstruction, prophylactic antibiotic use, and infection were collected. Chi squared analysis and the Mann-Whitney test compared complications.
Results:
Of 178 cases, prophylactic antibiotics were used in 45.5% (81/178). The prophylactic antibiotic group had an infection rate of 11.1% (9/81) versus 8.3% (8/97) in patients not receiving antibiotics, p = .52. Demographic, tumor, or surgical characteristics were not associated with an increased infection rate, p > .05.
Conclusion:
There is no decrease in infection rate of below the knee MMS with preoperative prophylactic antibiotics.
Insights
Prophylactic antibiotics did not decrease lower extremity infection rates in Mohs micrographic surgery (MMS). This study found similar infection rates whether or not patients received preoperative antibiotics for MMS below the knee.
Area of Science:
- Dermatology
- Surgical Oncology
- Infectious Disease
Background:
- Current guidelines recommend prophylactic antibiotics for Mohs micrographic surgery (MMS) on high-risk sites like lower extremities, based on a >5% infection rate.
- However, studies since 2008 have not demonstrated a reduction in infection rates with prophylactic antibiotic use.
Purpose of the Study:
- To evaluate the impact of preoperative prophylactic antibiotics on infection rates in patients undergoing MMS on the lower extremities.
Main Methods:
- A retrospective review of 178 adult patients undergoing MMS below the knee was performed.
- Patients from 2019-2021 received cefadroxil, while those from 2022-2024 did not.
- Infection rates were compared between groups using Chi-squared and Mann-Whitney tests.
Main Results:
- The infection rate was 11.1% in patients receiving prophylactic antibiotics (9/81) versus 8.3% in those not receiving them (8/97), with no statistically significant difference (p = .52).
- No demographic, tumor, or surgical characteristics were significantly associated with increased infection risk.
Conclusions:
- Preoperative prophylactic antibiotics do not appear to decrease the infection rate for MMS performed on the lower extremities.
- These findings suggest a potential re-evaluation of current antibiotic prophylaxis guidelines for this patient population.
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