Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial.

Abstract

OBJECTIVES:

There is limited published research studying the effect of antibiotic prophylaxis on surgical site infection (SSI) in dermatological surgery, and there is no consensus for its use in higher-risk cases. The objective of this study was to determine the effectiveness of a single oral preoperative 2 g dose of cephalexin in preventing SSI following flap and graft dermatological closures on the nose and ear.

DESIGN:

Prospective double-blinded, randomised, placebo-controlled trial testing for difference in infection rates.

SETTING:

Primary care skin cancer clinics in North Queensland, Australia, were randomised to 2 g oral cephalexin or placebo 40-60 min prior to skin incision.

PARTICIPANTS:

154 consecutive eligible patients booked for flap or graft closure following skin cancer excision on the ear and nose.

INTERVENTION:

2 g dose of cephalexin administered 40-60 min prior to surgery.

RESULTS:

Overall 8/69 (11.6%) controls and 1/73 (1.4%) in the intervention group developed SSI (p=0.015; absolute SSI reduction 10.2%; number needed to treat (NNT) for benefit 9.8, 95% CI 5.5 to 45.5). In males, 7/44 controls and 0/33 in the intervention group developed SSI (p=0.018; absolute SSI reduction 15.9%; NNT for benefit 6.3, 95% CI 3.8 to 19.2). SSI was much lower in female controls (1/25) and antibiotic prophylaxis did not further reduce this (p=1.0). There was no difference between the study groups in adverse symptoms attributable to high-dose antibiotic administration (p=0.871).

CONCLUSION:

A single oral 2 g dose of cephalexin given before complex skin closure on the nose and ear reduced SSI.

TRIAL REGISTRATION NUMBER:

ANZCTR 365115; Post-results.

• Authors: Helena Rosengren, Clare F Heal, Petra G Buttner
• Journal: BMJ open (BMJ Open) Vol. 8 Issue 4 Pg. e020213 (04 19 2018) ISSN: 2044-6055 [Electronic] England
• PMID: 29674370 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (administration & dosage)
• Antibiotic Prophylaxis
• Australia
• Dermatologic Surgical Procedures (adverse effects)
• Female
• Humans
• Male
• Middle Aged
• Nose (surgery)
• Prospective Studies
• Queensland
• Staphylococcus aureus
• Surgical Wound Infection (prevention & control)