In a single-institution study conducted in New Zealand reported in JAMA Surgery, Goh et al found that microdoses of incisional antibiotics may reduce the risk of surgical site infections during surgery for skin cancer, as well as reduce the risk of infections requiring postoperative systemic antibiotics.
Study Details
The double-blind trial involved adult patients presenting to a high-volume skin cancer treatment center in Auckland, New Zealand, for any form of skin cancer surgery over 6 months from February to July 2019.
A total of 681 evaluable patients with 721 total presentations and 1,133 total lesions were randomly assigned by presentation to receive an incision site injection of:
- Buffered local anesthetic alone (control group; 246 presentations and 388 lesions)
- Microdosed flucloxacillin at 500 μg/mL (206 presentations and 323 lesions)
- Microdosed clindamycin at 500 μg/mL (269 presentations and 422 lesions).
The primary endpoint was rate of postoperative surgical site infections with a standardized postoperative wound infection score of ≥ 5 per total number of lesions in each group.
Key Findings
A postoperative wound infection score of ≥ 5 was observed in 22 (5.7%) of 388 lesions from patients in the control group, 17 (5.3%) of 323 in the flucloxacillin group, and 9 (2.1%) of 422 in the clindamycin group (P = .01 vs control).
Postoperative systemic antibiotics were required for 31 (8.0%) of 388 lesions from patients in the control group, 13 (4.0%) of 323 in the flucloxacillin group (P = .03 vs control), and 9 (2.1%) of 422 in the clindamycin group (P < .001 vs control).
The investigators concluded, “This study evaluated the use of incisional antibiotics for surgical site infection prophylaxis in general skin cancer surgery and compared the efficacy of flucloxacillin vs clindamycin relative to control in cutaneous surgery. The significant reduction in surgical site infections with locally applied microdosed incisional clindamycin provides robust evidence to inform treatment guidelines in this area, which are currently lacking.”
Jon A. Mathy, MD, of the Faculty of Medical and Health Sciences, University of Auckland, is the corresponding author for the JAMA Surgery article.
Disclosure: The study was supported by a grant from the New Zealand Health Research Council. For full disclosures of the study authors, visit jamanetwork.com.
