Oral Antibiotics versus Topical Decolonization to Prevent Surgical Site Infections

The relative superiority of topical prophylaxis to oral prophylaxis for patients colonized with S. aureus was striking.

To determine the best method of preventing surgical site infections after Mohs micrographic surgery, investigators compared topical therapy and oral antibiotics in patients with nasal carriage of Staphylococcus aureus.

In this randomized, controlled trial, of 693 surgical patients undergoing Mohs at a single center, 179 were found to have S. aureus colonization preoperatively by nasal swab. The colonized patients were divided into two groups. One group received topical mupirocin to the nose twice daily plus once-daily body wash with chlorhexidine solution; the other group ingested 2000 mg of oral cephalexin 1 hour before the procedure and another 1000 mg dose 6 hours after. The overall rate of culture positive surgical site infections (SSIs) in all patients was 5.6% (39/693). Among the colonized patients, the rates of SSIs were 9% in oral antibiotic recipients (8/89) and 0% in patients who received topical cleansing – a statistically significant difference (P=0.003).

Comment

Limitations of this study include that it is from a single-center and that the 5.6% overall rate of surgical site infections was substantially higher than the <1% rate typically seen after Mohs surgery. Still, the relative superiority of topical prophylaxis to oral prophylaxis for patients colonized with S. aureus was striking. Even if the degree of protection were merely comparable, topical regimens may be preferred due to the lower risk for induction of antibiotic resistance. While no type of antibiotic prophylaxis is required perioperatively for Mohs surgery, when such prophylaxis is considered, topical regimens can be considered, keeping in mind that these may require greater patient effort and compliance.

Reviewing Author

Murad Alam, MD, MSCI

Disclosures

Consultant / Advisory boardAmway

Editorial boards JAMA Dermatology; Dermatologic Surgery; Journal of Cosmetic Dermatology; Lasers in Medical Science; Skin Therapy Letter

Leadership positions in professional societies American Academy of Dermatology (Chair, Health Care Finance Committee); American College of Mohs Surgery (Board of Directors); American Society for Dermatologic Surgery (Board of Directors)