Postoperative Infections in Dermatologic Surgery: The Role of Wound Cultures

Dermatol Surg. 2020 Oct;46(10):1294-1299. doi: 10.1097/DSS.0000000000002317.


Background: Dermatologic surgery is associated with low postoperative infection rates, averaging from approximately 1% to 4.25%. Often, postoperative infections are treated empirically based on clinical diagnosis of infection, given it can take 48 to 72 hours for a wound culture to identify a pathogen.

Objective: We aimed to evaluate the efficacy of empiric antibiotics in dermatologic surgery postoperative infections and if wound cultures change postoperative antibiotic therapy.

Methods: A 7-center, retrospective analysis of postoperative infections, with culture data, in dermatologic surgery patients was performed.

Results: Of 91 cases of clinically diagnosed postoperative infection, 82.4% (n = 75) were successfully treated with empiric oral antibiotics (95% confidence interval [0.73-0.89], p < .0001). In 16 (17.6%) cases, initial empiric antibiotics were unsuccessful, and wound culture results altered antibiotic therapy in 9 cases (9.9%) with 6 (6.6%) of these cases requiring additional coverage for methicillin-resistant Staphylococcus aureus (MRSA).

Conclusion: Empiric antibiotic treatment is usually appropriate for patients with postoperative surgical-site infections with wound cultures altering antibiotic management in a minority of cases. When empiric antibiotics fail, lack of MRSA coverage is usually the cause; therefore, providers should be aware of local MRSA prevalence and susceptibilities.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis / methods*
  • Bacteriological Techniques
  • Dermatologic Surgical Procedures / adverse effects*
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Male
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification*
  • Microbial Sensitivity Tests
  • Prevalence
  • Retrospective Studies
  • Skin Neoplasms / surgery
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / drug therapy*
  • Surgical Wound Infection / microbiology


  • Anti-Bacterial Agents