75% of American College of Mohs Surgery (ACMS) members prescribe prophylactic antibiotics

Aizman, Leora BS*; Barbieri, John S. MD, MBA†; Lukowiak, Tess M. BS‡; Perz, Allison M. BS§; Sobanko, Joseph F. MD†; Shin, Thuzar M. MD, PhD†; Higgins, Harold William MD†; Giordano, Cerrene N. MD†; Maher, Ian A. MD‖; Golda, Nicholas MD¶; Miller, Christopher J. MD†; Etzkorn, Jeremy R. MD, MS†. Attitudes on Prophylactic Antibiotic Use in Dermatologic Surgery: A Survey Study of American College of Mohs Surgery Members. Dermatologic Surgery: March 2021 - Volume 47 - Issue 3 - p 339-342 doi: 10.1097/DSS.0000000000002676

Clinical Pearls

• The majority of ACMS members prescribe prophylactic antibiotics for prevention of surgical site infections, most often in the form of postoperative antibiotics for an average of 6.56 days

• There is substantial variability in opinion on utility of prophylaxis in dermatological surgery, in part due to lack of randomized controlled data

• The overwhelming majority of ACMS members (>90%) report interest in randomized clinical trials assessing utility of prophylactic antibiotics in prevention of surgical site infections

Discussion:

There has been an increasing amount of antibiotics prescribed by Mohs surgeons, with a 69.6% increase in antibiotic prescriptions associated with dermatological surgical visits between 2008 and 2016. The reason for antibiotic prescriptions has been thought to be prophylactic in nature for prevention of surgical site infections. While there was an advisory statement published in the Journal of American Academy of Dermatology in 2008 on antibiotic prophylaxis in dermatologic surgery, there continues to be variability in clinical practice.

Therefore, the authors sought to understand current opinions and practice trends among Mohs surgeons on the role of prophylaxis for prevention of surgical site infections. This was studied via a survey sent to the 1,804 members of the American College of Mohs Surgery in November 2019.

This survey demonstrated a response rate of 5.60%, with a total of 101 ACMS members responding. Among those responding, 75.25% (76/101) routinely prescribed prophylactic antibiotics for prevention of surgical site infections. More specifically, 84.21% (64/76) of those prescribing prophylaxis do so in the postoperative period, with an average course lasting 6.56 days. While the majority of participating Mohs surgeons prescribe prophylactic antibiotics, 40.21% (39/97) of respondents noted uncertainty on the utility of prophylactic antibiotics in the prevention of surgical site infections. With the significant uncertainty on the use of prophylactic antibiotics, 90.63% (87/96) demonstrated interest in clinical trial data on efficacy of oral antibiotics for surgical site infection prevention. While this study sheds light on the use of prophylactic antibiotics & current opinions among those responding, a limitation includes potential for selection bias, given the response rate of 5.60%. Additionally, use of a survey as a method for this observational study increases risk of recall bias. What was overwhelmingly positive was the interest in randomized clinical trial data on the role of prophylaxis in dermatological surgery, which would allow for more stronger, evidence-based recommendations and would help elucidate the role of antibiotics in the setting of dermatological surgery.