BACKGROUND
Mohs micrographic surgery in general is associated with low rates of infection. As such, routine prophylactic antibiotics are not recommended. There are, however, several established risk factors for surgical site infection, including: lower leg site, skin grafts, skin flaps on the nose, wedge excisions of the lip or ear, and severe inflammatory skin disease.1 Nasal staphylococcus aureus carriage is also associated with higher rates of postoperative infection. Decolonization with intranasal mupirocin ointment and chlorhexidine body wash prior to Mohs micrographic surgery has been shown to reduce the infection rate for these carriers.2
In 2008, a working group from the Mayo Clinic reviewed prospective trials and obtained expert consensus to create an advisory statement on antibiotic prophylaxis in dermatologic surgery.1
To establish current antibiotic prescribing practices among Mohs micrographic surgeons in the United States, a 16-question online survey sent to all members of the American College of Mohs Surgery (ACMS) in October 2018 via email. The survey was approved by the Mount Sinai Health System Institutional Review Board. Data was collected for 1 month following distribution of the survey. Results were collated and analyzed in a confidential, anonymous fashion. The survey instrument characterized Mohs surgical experience, caseload and surgical setting. The prescription of prophylactic antibiotics was queried for both routine use and in the following surgical situations: nasal flaps, skin grafts, wedge excisions (lip and ear), leg surgery, and anogenital surgery. Prophylactic antibiotic use was also assessed for patients with specific comorbidities: artificial joint replacements, artificial cardiac valves, extensive inflammatory skin disease, and immunosuppression. Finally, respondents were asked if they routinely swabbed the nose for staphylococcus aureus carriage and decolonized carriers with topical antiseptic.
Descriptive statistics, including data distributions and cross-tabulation of the variables of interest were calculated. Pairwise analysis of polytomous variables was conducted using the Pearson chi-square test and an α level of 0.05.
In 2008, a working group from the Mayo Clinic reviewed prospective trials and obtained expert consensus to create an advisory statement on antibiotic prophylaxis in dermatologic surgery.1
To establish current antibiotic prescribing practices among Mohs micrographic surgeons in the United States, a 16-question online survey sent to all members of the American College of Mohs Surgery (ACMS) in October 2018 via email. The survey was approved by the Mount Sinai Health System Institutional Review Board. Data was collected for 1 month following distribution of the survey. Results were collated and analyzed in a confidential, anonymous fashion. The survey instrument characterized Mohs surgical experience, caseload and surgical setting. The prescription of prophylactic antibiotics was queried for both routine use and in the following surgical situations: nasal flaps, skin grafts, wedge excisions (lip and ear), leg surgery, and anogenital surgery. Prophylactic antibiotic use was also assessed for patients with specific comorbidities: artificial joint replacements, artificial cardiac valves, extensive inflammatory skin disease, and immunosuppression. Finally, respondents were asked if they routinely swabbed the nose for staphylococcus aureus carriage and decolonized carriers with topical antiseptic.
Descriptive statistics, including data distributions and cross-tabulation of the variables of interest were calculated. Pairwise analysis of polytomous variables was conducted using the Pearson chi-square test and an α level of 0.05.
RESULTS
There were 305 respondents (response rate of 18%) with collectively more than 7,634 years of Mohs experience. The surgical experience of the Mohs surgeons is illustrated in Figure 1 and Figure 2. The vast majority of surgeons performed Mohs surgery primarily in an outpatient setting or ambulatory surgical setting (95.0%).
Table 1 summarizes antibiotic usage and decolonization practices in Mohs micrographic surgery among respondents. Most
Table 1 summarizes antibiotic usage and decolonization practices in Mohs micrographic surgery among respondents. Most
