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An excuse to misuse? Evaluating the use of prophylactic antibiotics in elective skin graft surgery: a systematic review and meta-analysis

Introduction: Plastic surgeons may opt to administer prophylactic perioperative antibiotics in elective skin graft surgeries to curtail the risk of surgical site infections (SSI). However, the use of antibiotics brings the risk of adverse events or antibiotic resistance and evidence comparing the risk versus benefit is still lacking. Thus, there are no specific guidelines regarding the use of antibiotics prophylaxis in skin graft surgery and the potential for misuse of antibiotics is high. Methodology: A systematic literature search was conducted to retrieve all articles comparing the use versus nonuse of “prophylactic antibiotics” in “skin graft surgery” on March 29, 2020. All comparative study designs were considered for inclusion. The primary outcome was occurrence of SSI. A meta-analysis using the Mantel-Haenszel method with random effect model was used to pool the effect estimates from included studies. Result: A total of 1403 articles were identified, of which, 6 were included in the meta-analysis. The 6 articles included were all comparative studies (5 RCTs and 1 cohort study) and reported the outcomes of 391 patients and 404 grafts. A total of 202 patients received prophylactic antibiotics and 202 patients did not receive antibiotics. All 6 studies were included in the meta-analysis. The overall pooled effect estimates comparing treatment groups showed no significant difference for outcomes in terms of SSI (odds ratio: 0.43; 95% confidence interval: 0.18, 1.02; I2 0%; P=0.06). Conclusion: Incidence of SSI in elective skin graft surgery is relatively low. Our data shows there is limited utility in the use of prophylactic antibiotics to prevent clinically significant SSI in patients undergoing elective skin graft surgery. However, there are still only a small number of studies conducted on the topic to date, and more work is required before definitive conclusions can be used.