Postoperative Infections in Dermatologic Surgery: The Role of Wound Cultures

Comparison of Infection Rate Between Sterile and Nonsterile Gloves During Mohs Micrographic Surgery: An Updated Systematic Review and Meta-Analysis

BACKGROUND

Mohs micrographic surgery (MMS) is a well-established technique for the removal of various types of skin cancers. While sterile gloves (SG) are commonly used in skin surgeries such as MMS, additional understanding of their effectiveness compared to nonsterile gloves (NSG) in preventing local infection is required.

OBJECTIVE

We aimed to perform an updated systematic review and meta-analysis comparing the use of SG with NSG for local infection rate post-MMS and point out cost discrepancies between these 2 scenarios.

METHODS

We searched MEDLINE, Embase, and Cochrane for studies published up to August 2023 comparing the use of SG with NSG during MMS that reported the outcome of wound infection.

RESULTS

A total of 4 studies with 10,644 MMS were included, of which 7512 (70.6%) were performed with SG and 3132 (29.4%) were done with NSG. In the SG group, 232 out of 7512 cases (3.1%) developed infection compared to 64 out of 3132 (2.0%) in the NSG group [odds ratio (OR) 1.14; 95% confidence interval (CI) 0.85-1.52; P = .39; I2 = 0%]. Therefore, the post-MMS infection rates were not significantly different between SG and NSG groups, including in the excision (OR 0.92; 95% CI 0.48-1.79; P = .81; I2 = 0%) and reconstruction (OR 1.17; 95% CI 0.85-1.60; P = .34; I2 = 0%) subanalysis. Regarding the mean cost of the gloves, the NSG pair was $0.24, approximately 10% of the price of the SG pair ($2.27).

CONCLUSION

The results support that, compared to SG, NSG are equally effective in preventing infections during MMS while offering significant cost savings without compromising patient outcomes.Protocol registration: PROSPERO, CRD42023458525.

Characterization of an Escherichia coli phage Tequatrovirus YZ2 and its application in bacterial wound infection

The increasing prevalence of drug-resistant Escherichia coli (E. coli) resulting from the excessive utilization of antibiotics necessitates the immediate exploration of alternative approaches to counteract pathogenic E. coli. Phages, with their unique antibacterial mechanisms, are considered promising candidates for treating bacterial infections. Herein, we isolated a lytic Escherichia phage Tequatrovirus YZ2 (phage YZ2), which belongs to the genus Tequatrovirus. The genome of phage YZ2 consists of 168,356 base pairs with a G + C content of 35.34% and 269 putative open reading frames (ORFs). Of these, 146 ORFs have been annotated as functional proteins associated with nucleotide metabolism, structure, transcription, DNA replication, translation, and lysis. In the mouse model of a skin wound infected by E. coli, phage YZ2 therapy significantly promoted the wound healing. Furthermore, histopathological analysis revealed reductions in IL-1β and TNF-α and increased VEGF levels, indicating the potential of phages as effective antimicrobial agents against E. coli infection.

Antiseptic and Antibiotic Stewardship in Dermatologic Surgery: Is Benzoyl Peroxide the Solution?

Objective

We sought to review published literature on antibiotic and antiseptic use and resistance, and explore the utility of benzoyl peroxide in this capacity for dermatologic surgery.

Methods

A literature review was performed to investigate the skin microbiome, guidelines on antibiotic and antiseptic use in dermatologic surgery, and the utility of benzoyl peroxide as an antiseptic.

Results

Antiseptics are commonly used in dermatologic surgery to prepare surgical sites, and antibiotics are also employed by some physicians to prevent post-operative infection despite the potential for antibiotic resistance. Benzoyl peroxide, known for its high threshold for antibiotic resistance, has been successfully used in orthopedic surgery to prevent surgical site infection, especially in sebaceous areas of the skin which house a distinct microbiota.

Limitations

Limitations to this review include lack of high-quality, adequately powered research and studies which evaluate the clinical impact of anti-septic use, particularly benzoyl peroxide use, in dermatologic surgery.

Conclusion

Benzoyl peroxide may be a used as an antiseptic in dermatologic surgery of sebaceous areas to prevent post-operative infections, with a low likelihood of causing microbial resistance.

Surgical Site Infection After Dermatologic Procedures: Critical Reassessment of Risk Factors and Reappraisal of Rates and Causes

While rates are low, surgical site infections are the most common complication of dermatologic surgery. Surgical site infections have important consequences including impairment of wound healing, suboptimal cosmetic outcome, hospitalization, increased healthcare costs, and rarely, systemic infection. It is imperative to understand the risk factors and existing preventative measures to minimize the development of infection. This article reviews the available literature regarding surgical site infections following dermatologic procedures, to evaluate the standard of diagnosis and role of wound culture, risk factors, mimicking conditions, and significance of antibiotic prophylaxis. We offer a critical reassessment of the current literature on risk factors and reappraisal of infection rates to promote evidence-based patient care. We conclude that the strongest evidence suggests that diabetes mellitus is likely associated with increased surgical site infections. Immunosuppression is often clinically considered a risk factor; however, the evidence is mixed. In general the addition of antibiotics does not confer benefit except in high-risk sites. Conclusively, Mohs micrographic surgery has been proven safe in office and inpatient settings. We agree that sterile glove use for simple procedures is likely not a significant factor in the development of surgical site infections; however, we hypothesize that the overall sterile technique and setting may play a role in longer and/or more complex procedures.