Is a 100% antibiotic free oculoplastic surgery safe?

Overview & Synopsis

Purpose: to assess whether oculoplastic surgeries can be performed without any topical and systemic antibiotics, in a “100% antibiotic free” fashion. Method: we conducted a multicenter retrospective study between November 2017 and December 2022. Patients who underwent an oculoplastic procedure were screened. Patients who received prophylactic preoperative or postoperative systemic antibiotics were excluded. Intraoperative IV antibiotics were allowed. Patients were divided into two groups: those who were treated with local antibiotics ointments (LATB group) and those who were treated without local antibiotics ointments (LATB free group) postoperatively. The primary outcome was the incidence of surgical site infections (SSI). Results: among the 947 procedures (n=795 patients) included, 617 (n=505 patients) were included in the LATB group and 330 (n=229 patients) in the LATB free group. 853 and 80 procedures were classified Altemeier class 1 (clean) and class 2 (clean-contaminated) surgeries, respectively. Eighty-three (83/947; 8.76%) procedures were performed with intraoperative prophylactic IV antibiotics. Overall, 310 (32.73%) procedures were performed without any systemic nor topical antibiotics (100% antibiotic free fashion). Nine (9/947; 0.95%) patients experienced a postoperative SSI. SSI occurred in four (4/617; 0.65%) and five (5/330; 1.52%) patients in the LATB and LATB free group respectively, without any statistical difference between the groups (p=0.290). A subgroup analysis was carried out by excluding the procedures performed under intraoperative IV antibiotics and did not reveal any statistical difference between the two groups (p=0.144). All SSI patients were treated with systemic antibiotics with favorable outcomes. Postoperative wound dehiscence was the only risk factor associated with postoperative SSI in the multivariate analysis (p=0.002). Conclusion: this study suggests that performing a “100% antibiotic free” oculoplastic surgery without systemic and topical antibiotics is reasonable in Altemeier class 1 and class 2 procedures.