THE OCCURRENCE OF BACTEREMIA WITH SKIN SURGERY

The need for chemoprophylaxis for bacterial endocarditis is partly dep endent on the risk of bacteraemia associated with the procedure, which has not been adequately defined for skin surgery. The incidence of po stoperative bacteraemia in 149 immunocompetent out-patients with nonin fected lesions was 0.7% (95% CI 0.3-3.8%). Procedures included excisio ns, flaps, grafts and micrographically controlled surgery. Coagulase-n egative staphylococcus was the most common skin isolate at the site of surgery, present in 68.5% of patients. The most: effective chemoproph ylaxis would be intravenous vancomycin, which is inconvenient and has an inherent risk of morbidity. Given the low incidence of bacteraemia and the disadvantages of the optimum chemoprophylaxis, surgery on non- infected lesions does not warrant prophylactic antibiotics to prevent the very low risk of bacterial endocarditis.