Do preoperative microdosed incisional antibiotics reduce the rate of surgical site infections following skin cancer surgery?
This study found that an incision site injection of buffered local anesthetic with microdosed clindamycin (500 ug/mL) reduced the rate of postoperative surgical site infections and prescriptions for systemic antibiotics in patients undergoing skin cancer surgery.
Plan de l'etude:
Randomized controlled trial (double-blinded)
These investigators identified adults, who were not allergic to penicillin and clindamycin and had no history of any antibiotic use within the previous 7 days, who presented for skin cancer surgery under local anesthetic at a high-volume skin cancer treatment center in New Zealand. Eligible and consenting patients (N = 1215 lesions from 735 patients) randomly received an incision site injection of buffered local anesthetic alone (lidocaine 1% with epinephrine; the control group), buffered local anesthetic with microdosed flucloxacillin (500 ug/mL), or buffered local anesthetic with microdosed clindamycin (500 ug/mL). The most common surgery type was excision and direct closure. Individuals who assessed outcomes remained masked to treatment group assignment. Follow-up occurred for 93.3% of patients.
Using both intention-to-treat and per-protocol analyses, a clinically significant surgical site infection (defined as either  the presence of pus combined with erythema, edema, OR increased pain, or  hemoserous discharge combined with erythema, edema, AND increased pain) occurred significantly less often in the clindamycin group than in the flucloxacillin group or the control group (2.1% vs 5.3% and 5.7%, respectively; number needed to treat = 28; 95% CI 15 - 114). In addition, significantly fewer lesions required postoperative antibiotics during follow-up (clindamycin 2.1%; flucloxacillin 4.0%; control 8.0%). Results remained similar after adjusting for lesion type, including ulceration.
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill