Surgical site infections after microscopically controlled skin surgery in immunocompromised patients: a retrospective two-center cohort study
The data on the risk of surgical site infections (SSI) after skin surgery in patients undergoing immunosuppressive treatment are limited and the results of the existing single-center studies are controversial. At the same time, perioperative antibiotic prophylaxis (PAP) for immunocompromised patient...
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| Veröffentlicht in: | Archives of Dermatological Research 2020-09, Vol.312 (7), p.491-499 |
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| creator | Balakirski, Galina Löser, Christoph R. Dippel, Edgar Yazdi, Amir S. Artamonova, Inga Megahed, Mosaad Schmitt, Laurenz |
| description | The data on the risk of surgical site infections (SSI) after skin surgery in patients undergoing immunosuppressive treatment are limited and the results of the existing single-center studies are controversial. At the same time, perioperative antibiotic prophylaxis (PAP) for immunocompromised patients seems to be overused. We performed a retrospective analysis of the SSI rates after extensive dermatosurgical procedures performed from January 2017 to December 2017 in patients with impaired immune status due to a hematological disorder or immunosuppressive treatment at two German dermatosurgical centers. The SSI rate in immunocompromised patients was 6.7%. The independent risk factors for SSI found in the studied population were the occurrence of bleeding after one of the surgical stages and the use of oral anticoagulation with two different agents (the combination of acetylsalicylic acid and a direct oral anticoagulant). 44.4% (4/9) of the procedures complicated with an SSI involved wound closure with a skin flap, which was statistically significant (
p
= 0.041). Other risk factors identified were older age of the patients and increased duration of hospitalization (
p
|
| doi_str_mv | 10.1007/s00403-020-02035-8 |
| format | Article |
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p
= 0.041). Other risk factors identified were older age of the patients and increased duration of hospitalization (
p
< 0.05). Localization of the surgical site, number of surgical stages required for tumor clearance, and diabetes mellitus were not found to be statistically significant risk factors for occurrence of SSI in the studied population. SSI rates in immunocompromised patients undergoing skin surgery are low; therefore, we recommend against routine use of PAP for this cohort.</description><identifier>ISSN: 0340-3696</identifier><identifier>EISSN: 1432-069X</identifier><identifier>DOI: 10.1007/s00403-020-02035-8</identifier><identifier>PMID: 32009218</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Acetylsalicylic acid ; Age Factors ; Aged ; Anti-Bacterial Agents - therapeutic use ; Antibiotic Prophylaxis - statistics & numerical data ; Antibiotics ; Anticoagulants ; Anticoagulants - adverse effects ; Bacterial infections ; Cohort analysis ; Dermatology ; Diabetes mellitus ; Female ; Follow-Up Studies ; Health risk assessment ; Humans ; Immune clearance ; Immune status ; Immunocompromised Host ; Immunocompromised hosts ; Immunosuppressive Agents - adverse effects ; Localization ; Male ; Medicine ; Medicine & Public Health ; Mohs Surgery - adverse effects ; Original Paper ; Postoperative Hemorrhage - epidemiology ; Postoperative period ; Prophylaxis ; Retrospective Studies ; Risk Factors ; Skin ; Skin Neoplasms - immunology ; Skin Neoplasms - therapy ; Statistical analysis ; Surgery ; Surgical Flaps - adverse effects ; Surgical Flaps - transplantation ; Surgical site infections ; Surgical Wound Infection - epidemiology ; Surgical Wound Infection - etiology ; Surgical Wound Infection - prevention & control</subject><ispartof>Archives of Dermatological Research, 2020-09, Vol.312 (7), p.491-499</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-2524efea4f78ac9207ceca7ec10187ba773abd8e5dce689338f3d96c369171653</citedby><cites>FETCH-LOGICAL-c375t-2524efea4f78ac9207ceca7ec10187ba773abd8e5dce689338f3d96c369171653</cites><orcidid>0000-0002-6093-9832</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00403-020-02035-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00403-020-02035-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32009218$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Balakirski, Galina</creatorcontrib><creatorcontrib>Löser, Christoph R.</creatorcontrib><creatorcontrib>Dippel, Edgar</creatorcontrib><creatorcontrib>Yazdi, Amir S.</creatorcontrib><creatorcontrib>Artamonova, Inga</creatorcontrib><creatorcontrib>Megahed, Mosaad</creatorcontrib><creatorcontrib>Schmitt, Laurenz</creatorcontrib><title>Surgical site infections after microscopically controlled skin surgery in immunocompromised patients: a retrospective two-center cohort study</title><title>Archives of Dermatological Research</title><addtitle>Arch Dermatol Res</addtitle><addtitle>Arch Dermatol Res</addtitle><description>The data on the risk of surgical site infections (SSI) after skin surgery in patients undergoing immunosuppressive treatment are limited and the results of the existing single-center studies are controversial. At the same time, perioperative antibiotic prophylaxis (PAP) for immunocompromised patients seems to be overused. We performed a retrospective analysis of the SSI rates after extensive dermatosurgical procedures performed from January 2017 to December 2017 in patients with impaired immune status due to a hematological disorder or immunosuppressive treatment at two German dermatosurgical centers. The SSI rate in immunocompromised patients was 6.7%. The independent risk factors for SSI found in the studied population were the occurrence of bleeding after one of the surgical stages and the use of oral anticoagulation with two different agents (the combination of acetylsalicylic acid and a direct oral anticoagulant). 44.4% (4/9) of the procedures complicated with an SSI involved wound closure with a skin flap, which was statistically significant (
p
= 0.041). Other risk factors identified were older age of the patients and increased duration of hospitalization (
p
< 0.05). Localization of the surgical site, number of surgical stages required for tumor clearance, and diabetes mellitus were not found to be statistically significant risk factors for occurrence of SSI in the studied population. SSI rates in immunocompromised patients undergoing skin surgery are low; therefore, we recommend against routine use of PAP for this cohort.</description><subject>Acetylsalicylic acid</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotic Prophylaxis - statistics & numerical data</subject><subject>Antibiotics</subject><subject>Anticoagulants</subject><subject>Anticoagulants - adverse effects</subject><subject>Bacterial infections</subject><subject>Cohort analysis</subject><subject>Dermatology</subject><subject>Diabetes mellitus</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Immune clearance</subject><subject>Immune status</subject><subject>Immunocompromised Host</subject><subject>Immunocompromised hosts</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Localization</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mohs Surgery - adverse effects</subject><subject>Original Paper</subject><subject>Postoperative Hemorrhage - epidemiology</subject><subject>Postoperative period</subject><subject>Prophylaxis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Skin</subject><subject>Skin Neoplasms - immunology</subject><subject>Skin Neoplasms - therapy</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surgical Flaps - adverse effects</subject><subject>Surgical Flaps - transplantation</subject><subject>Surgical site infections</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>Surgical Wound Infection - etiology</subject><subject>Surgical Wound Infection - prevention & control</subject><issn>0340-3696</issn><issn>1432-069X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1TAQhS0EoldtX4AFssSGTWBsJ7HDDlXlR6rEoiCxs3ydCbgkcbAd0H2IvjMTbgGJRS1ZXsx3ZsbnMPZEwAsBoF9mgBpUBRK2q5rKPGA7UStZQdt9fsh2oGqoVNu1J-w85xugo6GWoB-zEyUBOinMjt1er-lL8G7kORTkYR7QlxDnzN1QMPEp-BSzj8vGjAfu41xSHEfsef4WZp5JjulAQh6maZ2jj9OS4hQyEYsrAeeSX3HHE5IuL1v3H8jLz1h5KtEEH7_GVHgua384Y48GN2Y8v3tP2ac3lx8v3lVXH96-v3h9VXmlm1LJRtY4oKsHbZzv6E8evdPoBQij905r5fa9wab32JpOKTOovms9uSG0aBt1yp4f-9Kq31fMxdLCHsfRzRjXbKVqyFJFLKHP_kNv4ppm2s7KWkojOyk1UfJIbW7lhINdUphcOlgBdsvLHvOylJX9nZc1JHp613rdT9j_lfxJhwB1BDKVZvL53-x72v4CRuCj5g</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Balakirski, Galina</creator><creator>Löser, Christoph R.</creator><creator>Dippel, Edgar</creator><creator>Yazdi, Amir S.</creator><creator>Artamonova, Inga</creator><creator>Megahed, Mosaad</creator><creator>Schmitt, Laurenz</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6093-9832</orcidid></search><sort><creationdate>20200901</creationdate><title>Surgical site infections after microscopically controlled skin surgery in immunocompromised patients: a retrospective two-center cohort study</title><author>Balakirski, Galina ; Löser, Christoph R. ; Dippel, Edgar ; Yazdi, Amir S. ; Artamonova, Inga ; Megahed, Mosaad ; Schmitt, Laurenz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-2524efea4f78ac9207ceca7ec10187ba773abd8e5dce689338f3d96c369171653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acetylsalicylic acid</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotic Prophylaxis - statistics & numerical data</topic><topic>Antibiotics</topic><topic>Anticoagulants</topic><topic>Anticoagulants - adverse effects</topic><topic>Bacterial infections</topic><topic>Cohort analysis</topic><topic>Dermatology</topic><topic>Diabetes mellitus</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Immune clearance</topic><topic>Immune status</topic><topic>Immunocompromised Host</topic><topic>Immunocompromised hosts</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Localization</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mohs Surgery - adverse effects</topic><topic>Original Paper</topic><topic>Postoperative Hemorrhage - epidemiology</topic><topic>Postoperative period</topic><topic>Prophylaxis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Skin</topic><topic>Skin Neoplasms - immunology</topic><topic>Skin Neoplasms - therapy</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Surgical Flaps - adverse effects</topic><topic>Surgical Flaps - transplantation</topic><topic>Surgical site infections</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>Surgical Wound Infection - etiology</topic><topic>Surgical Wound Infection - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Balakirski, Galina</creatorcontrib><creatorcontrib>Löser, Christoph R.</creatorcontrib><creatorcontrib>Dippel, Edgar</creatorcontrib><creatorcontrib>Yazdi, Amir S.</creatorcontrib><creatorcontrib>Artamonova, Inga</creatorcontrib><creatorcontrib>Megahed, Mosaad</creatorcontrib><creatorcontrib>Schmitt, Laurenz</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of Dermatological Research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Balakirski, Galina</au><au>Löser, Christoph R.</au><au>Dippel, Edgar</au><au>Yazdi, Amir S.</au><au>Artamonova, Inga</au><au>Megahed, Mosaad</au><au>Schmitt, Laurenz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical site infections after microscopically controlled skin surgery in immunocompromised patients: a retrospective two-center cohort study</atitle><jtitle>Archives of Dermatological Research</jtitle><stitle>Arch Dermatol Res</stitle><addtitle>Arch Dermatol Res</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>312</volume><issue>7</issue><spage>491</spage><epage>499</epage><pages>491-499</pages><issn>0340-3696</issn><eissn>1432-069X</eissn><abstract>The data on the risk of surgical site infections (SSI) after skin surgery in patients undergoing immunosuppressive treatment are limited and the results of the existing single-center studies are controversial. At the same time, perioperative antibiotic prophylaxis (PAP) for immunocompromised patients seems to be overused. We performed a retrospective analysis of the SSI rates after extensive dermatosurgical procedures performed from January 2017 to December 2017 in patients with impaired immune status due to a hematological disorder or immunosuppressive treatment at two German dermatosurgical centers. The SSI rate in immunocompromised patients was 6.7%. The independent risk factors for SSI found in the studied population were the occurrence of bleeding after one of the surgical stages and the use of oral anticoagulation with two different agents (the combination of acetylsalicylic acid and a direct oral anticoagulant). 44.4% (4/9) of the procedures complicated with an SSI involved wound closure with a skin flap, which was statistically significant (
p
= 0.041). Other risk factors identified were older age of the patients and increased duration of hospitalization (
p
< 0.05). Localization of the surgical site, number of surgical stages required for tumor clearance, and diabetes mellitus were not found to be statistically significant risk factors for occurrence of SSI in the studied population. SSI rates in immunocompromised patients undergoing skin surgery are low; therefore, we recommend against routine use of PAP for this cohort.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32009218</pmid><doi>10.1007/s00403-020-02035-8</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6093-9832</orcidid></addata></record> |
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| subjects | Acetylsalicylic acid Age Factors Aged Anti-Bacterial Agents - therapeutic use Antibiotic Prophylaxis - statistics & numerical data Antibiotics Anticoagulants Anticoagulants - adverse effects Bacterial infections Cohort analysis Dermatology Diabetes mellitus Female Follow-Up Studies Health risk assessment Humans Immune clearance Immune status Immunocompromised Host Immunocompromised hosts Immunosuppressive Agents - adverse effects Localization Male Medicine Medicine & Public Health Mohs Surgery - adverse effects Original Paper Postoperative Hemorrhage - epidemiology Postoperative period Prophylaxis Retrospective Studies Risk Factors Skin Skin Neoplasms - immunology Skin Neoplasms - therapy Statistical analysis Surgery Surgical Flaps - adverse effects Surgical Flaps - transplantation Surgical site infections Surgical Wound Infection - epidemiology Surgical Wound Infection - etiology Surgical Wound Infection - prevention & control |
| title | Surgical site infections after microscopically controlled skin surgery in immunocompromised patients: a retrospective two-center cohort study |
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