Perioperative antibiotic prophylaxis in skin surgery – Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 1: Procedure‐ and patient‐related risk factors

Abstract

SummaryThe aim of perioperative antibiotic prophylaxis (PAP) is to prevent the occurrence of surgical site infections (SSIs) or other infectious complications (especially bacterial endocarditis or septic arthritis). PAP is effective in surgeries where overall infection rates are high even without considering patient‐related risk factors (such as orthopedic surgery or fracture repair). Surgery on airways, gastrointestinal, genital, or urinary tract is also considered to be associated with a risk of infection and may require PAP. Overall, SSIs in skin surgery are relatively rare and vary between 1% and 11% depending on the localization, complexity of the wound closure and patient cohort. Therefore, the general surgical recommendations regarding PAP only partially reflect the needs of dermatologic surgery. In contrast to the USA, where recommendations on the use of PAP in skin surgery already exist, there are currently no guidelines for the use of PAP specifically designed for dermatologic surgery in Germany. In the absence of an evidence‐based recommendation, the use of PAP is guided by the experience of the surgeons and leads to a heterogeneous use of antimicrobial substances. In this work, we summarize the current scientific literature on the use of PAP and make a recommendation depending on procedure‐ and patient‐related risk factors.

Perioperative antibiotic prophylaxis in skin surgery – Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 2: Special indications and situations

“…In Part 1 of this position paper, we discussed procedure‐ and patient‐related risk factors for the development of SSI and the use of PAP for SSI prevention 1 . In general, PAP should be avoided in most elective skin surgeries.…”

“…The exceptions are combinations of several relevant risk factors. PAP may, for example, be considered in individual cases for closure of large wound defects of > 4 cm 2 with skin flaps 1,2 . In addition, special localizations (such as lower leg or ear) have, in combination with other risk factors like immunosuppression, a tendency to develop SSIs and may justify the use of PAP (Figure 1).…”

“…SSI and the use of PAP for SSI prevention. 1 In general, PAP should be avoided in most elective skin surgeries. The exceptions are combinations of several relevant risk factors.…”

“…PAP may, for example, be considered in individual cases for closure of large wound defects of > 4 cm 2 with skin flaps. 1,2 In addition, special localizations (such as lower leg or ear) have, in combination with other risk factors like immunosuppression, a tendency to develop SSIs and may justify the use of PAP (Figure 1). 1,2 In this second part, the authors discuss specific PAP indications, such as prophylaxis of bacterial endocarditis or hematogenous joint prosthesis infection, as well as PAP in special situations (for example, in the context of septic surgeries).…”

Perioperative Antibiotikaprophylaxe in der Dermatochirurgie – Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 2: Spezielle Indikationen und Situationen

“…Ausnahmen stellen Kombinationen relevanter Risikofaktoren dar. So kann beim Verschluss großer Wunddefekte mit einer Fläche >4 cm 2 mittels Lappenplastik im Einzelfall eine PAP erwogen werden 1,2 . Auch spezielle Lokalisationen wie der Unterschenkel oder das Ohr neigen in Kombination mit anderen Risikofaktoren wie beispielsweise Immunsuppression zur Entwicklung eines SSI und können eine PAP rechtfertigen (Abbildung 1).…”