Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
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Randomized Controlled Trial Comparative Study
Oral antibiotics versus topical decolonization to prevent surgical site infection after Mohs micrographic surgery--a randomized, controlled trial.
The optimal method of reducing the risk of surgical site infection (SSI) after dermatologic surgery is unclear. Empiric, preoperative antibiotic use is common practice but lacks supporting evidence for its efficacy in preventing SSI. Risk stratification for patients at high risk of postoperative SSI based on a nasal swab is a viable strategy when coupled with topical decolonization for positive carriers. We compared the rates of infection in patients undergoing Mohs micrographic surgery (MMS) with nasal carriage of Staphylococcus aureus who received oral antibiotics or topical decolonization. ⋯ In patients with demonstrable carriage of S. aureus, topical decolonization resulted in fewer SSI than in patients receiving perioperative oral antibiotics. Antibiotics should be reserved for clinically suspected and swab-proven infections rather than being prescribed empirically. Further efforts should be directed toward optimizing endogenous risk factor control for all patients presenting for MMS.