The incidence of bacteremia in skin surgery of the head and neck

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Abstract

The normal microflora of skin vary significantly between sebaceous rich, wet, and dry areas. This would be expected to influence the likelihood of developing transient bacteremia while undergoing skin surgery on these different areas, thereby affecting the risk of infective endocarditis from such procedures. We evaluated the incidence of transient bacteremia in 45 patients undergoing skin surgery on the sebaceous rich areas of the head and neck. After surveillance skin cultures, aerobic and anaerobic blood culture samples were taken at 0, 1, 5, and 15 minutes after the start of the procedure. All baseline blood culture results were negative. Three of the 45 patients developed transient bacteremia within the first 15 minutes after the start of the procedures. Samples from two patients grew pure cultures of Propionibacterium acnes and that from one patient grew a pure culture of Staphylococcus hominis, yielding a 7% incidence of bacteremia in the 45 patients studied. These data support the use of perioperative prophylactic antibiotics for surgery involving clinically uninfected skin of the head and neck only in patients with prosthetic heart valves. This is in keeping with the current recommendations of the American Heart Association against the need for antibiotic prophylaxis for nonprosthetic valve endocarditis in patients undergoing cutaneous surgery on clinically uninfected skin.

References (16)

  • JJ Leyden et al.

    Age related changes in the resident bacterial flora of the human face

    J Invest Dermatol

    (1975)
  • DT Durack

    Prophylaxis of infective endocarditis

  • ST Shulman et al.

    Prevention of bacterial endocarditis

    Circulation

    (1984)
  • JH Richards

    Bacteremia following irritation of foci of infection

    JAMA

    (1983)
  • BC Fine et al.

    Incision and drainage of soft tissue abscesses and bacteremia

    Ann Intern Med

    (1985)
  • JJ Leyden et al.

    Skin microflora

    J Invest Dermatol

    (1987)
  • JB Sabetta et al.

    The incidence of bacteremia during skin surgery

    Arch Dermatol

    (1987)
  • KJ McGinley et al.

    Regional variations of propianobacteria

    Appl Environ Microbiol

    (1978)
There are more references available in the full text version of this article.

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1

From the Department of Dermatology, Hospital of the University of Pennsylvania.

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