Do perioperative antibiotics reduce the risk of surgical site infections following excision of ulcerated skin cancers? a critically appraised topic

Summary

Aim

To review the efficacy of perioperative antibiotics in reducing the risk of surgical site infections (SSI) following excision of ulcerated skin cancers.

Setting and Design

Study selection, data extraction and analysis were carried out independently by four authors. Only randomised controlled trials (RCTs) reported in the English Language were included.

Included studies

Randomised controlled trials (RCTs) in the English language in which patients received perioperative topical, intralesional, or oral antibiotics for dermatological surgery including Mohs micrographic surgery in General Practice, Dermatology or Plastic Surgery Departments were included.

Outcome

The proportion of participants developing surgical site infection (SSI) following excision of skin lesions.

Results

Thirteen RCTs^{17-20,26-33,35} were identified from our literature search of Pubmed and Embase which evaluated SSI following use of topical (n=5)^26-29,35, oral (n=3)^17-19, intramuscular (n=2)^20,32, intravenous (n=1)³³ and intralesional antibiotics (n=2)^30,31 in dermatological surgery. Two RCTs specifically investigated SSI in ulcerated skin cancer excisions; one RCT investigated SSI rate following surgical treatment specifically for ulcerated skin cancers in individuals randomised to topical antibiotics versus oral cephalexin and one RCT compared intravenous cefazolin to no antibiotic demonstrating significant reduction in SSI rates for ulcerated tumours (p=0.04).

Conclusion

The heterogeneity of the RCTs included in this study makes it difficult to make a direct comparison of the outcomes measured. High quality evidence demonstrating a beneficial effect of the use of peri-operative antibiotics to prevent SSI following excision of ulcerated skin cancers is lacking. In the absence of an evidence-base, we propose that a well-designed multi-centred RCT could evaluate the effect of peri-operative antibiotics following excision of ulcerated tumours, and potentially reduce inappropriate antibiotic prescribing.

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