Schlager Justin Gabriel, Hartmann Daniela, Kendziora Benjamin
Klinik und Poliklinik für Dermatologie und Allergologie, LMU Klinikum - Campus Innenstadt, Frauenlobstr. 9-11, 80337, München, Deutschland.
Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude West 38 (W38), Hamburg, Deutschland.
Dermatologie (Heidelb). 2023 Nov;74(11):827-834. doi: 10.1007/s00105-023-05233-3. Epub 2023 Oct 12.
Postoperative wound infections represent the most common complication in dermatosurgery. Given the low incidence and heterogeneous data, no standards for perioperative antibiotic prophylaxis (PAP) have been established in clinical practice.
To summarize the current evidence on risk factors for postoperative wound infection in dermatosurgery and the new recommendations on PAP.
Relevant study data and current recommendations were summarized descriptively.
Current evidence suggests that the following factors are associated with an increased risk of wound infection after dermatosurgical procedures: surgery to the lower extremity or the ear, postoperative hemorrhage, defect closure by flap or skin graft, large wound defect, immunosuppression, and male sex. Probably not affecting the risk of infection are diabetes, obesity, age, smoking, use of a blood thinner, multiple surgeries, or wound healing by second intention. Not all risk factors affect the risk of infection equally. They must be weighted differently and only in combination do they increase the risk of wound infection in a clinically relevant way. According to a current position paper of the German Society for Dermatosurgery, the indication for PAP should be made individually and only if multiple factors are present. Furthermore, patients with increased risk for bacterial endocarditis or hematogenic endoprosthesis infection should receive PAP prior to septic skin surgery.
In dermatologic surgery, PAP should be restricted to patients at high risk for wound infection. Further indications are the prevention of bacterial endocarditis and hematogenic endoprosthesis infection in high-risk individuals prior to septic surgery.
术后伤口感染是皮肤外科手术中最常见的并发症。鉴于其发病率低且数据参差不齐，临床实践中尚未确立围手术期抗生素预防（PAP）的标准。
总结皮肤外科手术后伤口感染危险因素的现有证据以及PAP的新建议。
对相关研究数据和当前建议进行描述性总结。
现有证据表明，以下因素与皮肤外科手术后伤口感染风险增加相关：下肢或耳部手术、术后出血、皮瓣或植皮闭合缺损、大的伤口缺损、免疫抑制和男性。糖尿病、肥胖、年龄、吸烟、使用血液稀释剂、多次手术或二期愈合可能不会影响感染风险。并非所有危险因素对感染风险的影响都相同。它们的权重必须有所不同，只有综合起来才会以临床相关的方式增加伤口感染风险。根据德国皮肤外科学会的一份当前立场文件，PAP的指征应个体化确定，且仅在存在多种因素时使用。此外，细菌性心内膜炎或血源性人工假体感染风险增加的患者在进行脓毒性皮肤手术前应接受PAP。
在皮肤科手术中，PAP应仅限于伤口感染高风险患者。进一步的指征是在脓毒性手术前预防高危个体的细菌性心内膜炎和血源性人工假体感染。
