From the Guidelines
Post-surgical skin infections should be treated with a combination of wound care and antimicrobial therapy, with the choice of antibiotic depending on the severity of the infection and the suspected causative pathogen, as recommended by the Infectious Diseases Society of America guidelines 1. The treatment of post-surgical skin infections involves a range of strategies, including:
- Wound care: cleaning with sterile saline, removing necrotic tissue, and applying appropriate dressings
- Antimicrobial therapy: topical or oral antibiotics, with the choice of antibiotic depending on the severity of the infection and the suspected causative pathogen
- Surgical intervention: debridement or drainage of abscesses may be necessary in some cases For mild superficial infections, topical antibiotics like mupirocin or bacitracin may be sufficient, while for moderate to severe infections, oral antibiotics such as cephalexin, dicloxacillin, or clindamycin may be recommended 1. In cases of suspected MRSA, consider trimethoprim-sulfamethoxazole or doxycycline, and for severe infections or those with systemic symptoms, intravenous antibiotics like vancomycin, piperacillin-tazobactam, or cefazolin may be necessary 1. The 2021 WHO Essential Medicines List recommends amoxicillin-clavulanic acid, cloxacillin, and cefalexin as first-line options for skin and soft tissue infections, with clindamycin and piperacillin-tazobactam recommended for necrotizing fasciitis 1. The 2018 WSES/SIS-E consensus conference recommends that incisional SSIs be drained, irrigated, and if needed, opened and debrided, with empiric broad-spectrum antibiotic treatment initiated in patients with systemic inflammatory response criteria or signs of organ failure 1. Key factors to consider when treating post-surgical skin infections include:
- Host factors: age, malnutrition status, diabetes, smoking, obesity, colonization with microorganisms
- Pathogen factors: suspected causative pathogen, antibiotic resistance patterns
- Infection severity: mild, moderate, or severe, with or without systemic symptoms
- Wound characteristics: depth, size, location, presence of necrotic tissue or abscesses.
From the FDA Drug Label
SKIN AND SKIN STRUCTURE INFECTIONS Caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Viridans group streptococci, Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Morganella morganii, Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter calcoaceticus, Bacteroides fragilis or Peptostreptococcus species SURGICAL PROPHYLAXIS The preoperative administration of a single 1 gram dose of Ceftriaxone for Injection may reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated
The treatment guidelines for post-surgical skin infections include the use of Ceftriaxone for skin and skin structure infections caused by susceptible organisms, such as Staphylococcus aureus and Streptococcus pyogenes. Additionally, Ceftriaxone can be used as surgical prophylaxis to reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated 2.
Key points:
- Ceftriaxone is effective against a range of bacteria that can cause skin and skin structure infections
- Ceftriaxone can be used as surgical prophylaxis to reduce the incidence of postoperative infections
- The use of Ceftriaxone should be guided by culture and susceptibility results, when available 2.
From the Research
Treatment Guidelines for Post-Surgical Skin Infections
- The Surgical Infection Society (SIS) guidelines for the treatment of complicated skin and soft tissue infections (SSTIs) were updated in 2021, providing a succinct update on the earlier guidelines based on an additional decade of data 3.
- The updated guidelines suggest that most recommendations remain unchanged from the original guidelines, with the exception of increased support for adjuvant antimicrobial therapy after drainage of complex abscesses and increased data for the use of alternative antimicrobial agents 3.
- A meta-analysis of clinical trials comparing cefazolin to cefuroxime, ceftriaxone, and cefamandole for surgical site infection prevention found that cefazolin is as effective as these agents in preventing surgical site infections 4.
- Current guidelines for the diagnosis and treatment of surgical skin and soft tissue infections emphasize the importance of timely and appropriate antimicrobial therapy, as well as surgical intervention when necessary 5.
Antibiotic Prophylaxis
- Cefazolin is recommended as a first-line agent for prophylaxis of postoperative infections in aseptic (clean) operations, due to its excellent pharmacokinetics and good activity against gram-positive pathogens 6.
- In operations where violation of the digestive tract creates a contaminated field, a cefotaxime-generation cephalosporin is the agent of choice, due to its excellent safety profile and capability to kill essentially all pathogenic gram-negative aerobes and a substantial portion of anaerobes 6.
- A study comparing cefazolin to second-line antibiotics for surgical site infection prevention after total joint arthroplasty among patients with a beta-lactam allergy found that cefazolin was associated with decreased postoperative SSI without an increase in interoperative hypersensitivity reactions 7.
Key Considerations
- The selection of antibiotic prophylaxis depends on the nature of the operation and the potential pathogens involved 6.
- Single-dose prophylaxis is effective, inexpensive, and does not induce bacterial resistance 6.
- The use of cefazolin as a perioperative antibiotic for infection prophylaxis in total joint arthroplasty in patients labeled beta-lactam allergic is associated with decreased postoperative SSI without an increase in interoperative hypersensitivity reactions 7.