Postoperative Infections in Dermatologic Surgery: The Role of Wound Cultures. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: Ken, Kimberly M.; Johnson, Mariah M.; Leitenberger, Justin J.; Neal, Donald E.; Etzkorn, Jeremy R.; Govas, Panayiota; Carroll, Bryan T.; Badawi, Ahmed H.; Mudigonda, Tejaswi; Council, M. Laurin; Avila, Christina; Carr, David R.; Sasaki, Jodie; Blalock, Travis W.; Golda, Nicholas J.
• Is Part Of: Dermatologic surgery. Volume 46:Issue 10(2020)
• Publication Date: 2020-10
• Subjects: Skin -- Surgery -- Periodicals; Skin -- Diseases -- Surgery -- Periodicals; 617.477
• DOI: 10.1097/DSS.0000000000002317
• Languages: English
• ISSNs: 1076-0512

Abstract

Abstract : BACKGROUND: Dermatologic surgery is associated with low postoperative infection rates, averaging from approximately 1% to 4.25%. Often, postoperative infections are treated empirically based on clinical diagnosis of infection, given it can take 48 to 72 hours for a wound culture to identify a pathogen. OBJECTIVE: We aimed to evaluate the efficacy of empiric antibiotics in dermatologic surgery postoperative infections and if wound cultures change postoperative antibiotic therapy. METHODS: A 7-center, retrospective analysis of postoperative infections, with culture data, in dermatologic surgery patients was performed. RESULTS: Of 91 cases of clinically diagnosed postoperative infection, 82.4% ( n = 75) were successfully treated with empiric oral antibiotics (95% confidence interval [0.73–0.89], p < .0001). In 16 (17.6%) cases, initial empiric antibiotics were unsuccessful, and wound culture results altered antibiotic therapy in 9 cases (9.9%) with 6 (6.6%) of these cases requiring additional coverage for methicillin-resistant Staphylococcus aureus (MRSA). CONCLUSION: Empiric antibiotic treatment is usually appropriate for patients with postoperative surgical-site infections with wound cultures altering antibiotic management in a minority of cases. When empiric antibiotics fail, lack of MRSA coverage is usually the cause; therefore, providers should be aware of local MRSA prevalence and susceptibilities. Abstract : Supplemental Digital Content is Available in the Text.