Prophylactic antibiotics and Postoperative Surgical Site Infections in cutaneous surgery: A systematic review and meta-analysis

Introduction: The risks and benefits of antibiotic prophylaxis (AP) in the setting of dermatologic surgery are unclear. This meta-analysis evaluated the effect of AP on the risk of SSIs and adverse events (AE) of AP in clean and clean/contaminated cutaneous surgical procedures. Methods: Embase, MEDLINE, and Scopus databases were searched from inception through August 16, 2021. Two reviewers independently selected randomized controlled trials (RCTs) in which participants undergoing elective clean and clean/contaminated surgical procedures received either an identified course of AP, or no AP or a placebo. Data extracted were surgery type, antibiotic and control interventions, occurrence of SSIs and adverse events (AEs). SSI risk was pooled across trials by using a random-effects model. Certainty of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Twenty-eight RCTs (12,958 surgical wounds in 12,698 participants) were included. Postoperative SSIs were reduced in the AP group compared with controls (3.4% vs 7.4%; incidence rate ratio [IRR], 0.48 [95% CI, 0.37–0.62]; high certainty of evidence). Subgroup analysis showed a reduction in SSI risk for Mohs micrographic surgery (IRR, 0.22 [95% CI, 0.09–0.51]), dermatologic surgery (IRR, 0.29 [95% CI, 0.14–0.60]), and plastic or breast surgery (IRR, 0.60 [95% CI, 0.45–0.80]). Risk of AEs was not different between AP and control groups. Conclusion: AP reduces SSI risk in clean and clean/contaminated cutaneous surgical procedures. The benefits of AP should be balanced against costs, drug interactions, antibiotic resistance, and surgical sites or procedures that are associated with a lower likelihood of infection.