The following is a summary of “Antibiotic Use and Surgical Site Infections in Immunocompromised Patients After Mohs Micrographic Surgery: A Single-Center Retrospective Study” published in the December 2022 issue of Dermatologic Surgery by Nguyen et al.

The hazards of doing Mohs micrographic surgery on immunosuppressed patients should be carefully considered as the procedure gains popularity. The goals of this study are to ascertain whether immunosuppressed patients are at an elevated risk for surgical site infection and  to assess the efficacy of postoperative antibiotics in preventing surgical site infection.

The patients who had Mohs micrographic surgery between October 9, 2014, and August 20, 2021, were reviewed retrospectively. The total number of unique cases found was 5,886. Preoperative lesion size of more than 40 mm (86.7%, n=13; P<.01) and high-risk lesion location (46.4%, n=1,268; P<.01) were factors associated with a higher incidence of antibiotic administration. Patients with immunosuppression were not more likely to use antibiotics (37.0% vs. 34.2% ; P=.14), and immunosuppression was not independently linked with antibiotic use on multivariate analysis (odds ratio 1.2, 95% CI 1.0-1.5). 

The infection rate in immunocompromised individuals was 2.1% (n=15) and in immunocompetent patients was 1.6% (n=80) (P=.30). Antibiotics were not effective in preventing infections in immunocompromised patients (3.0%, n=8 versus 1.5%, n=7; P=.19). Immunosuppression did not seem to affect the frequency of infections after surgery. Moreover, these patients should not be prescribed postoperative antibiotics unless additional high-risk characteristics are present.