LAUSR

PURPOSE The utility of topical antibiotic prophylaxis for routine oculofacial plastic surgery is not well-established. Given concerns such as contact dermatitis, antibiotic resistance, and healthcare costs, in conjunction with a low baseline rate of surgical site infections, the investigators sought to determine the frequency of infection with and without the use of topical antibiotic prophylaxis. DESIGN Randomized, controlled, unmasked clinical trial. PARTICIPANTS Adult patients undergoing routine periocular surgery without prior history of periocular surgical site infection, need for perioperative oral or parenteral antibiotics, or allergy to all study medications. METHODS Participants were randomized pre-operatively to receive either antibiotic or placebo (mineral oil/petrolatum-based) ointment after surgery. Outcomes were measured at the first post-operative visit. The two-tailed Fisher's exact test was used to compare outcomes between groups. MAIN OUTCOME MEASURES The primary outcome was the incidence of surgical site infections. The secondary outcomes included stratification of infections by patient risk characteristics, incidence of allergic contact dermatitis, and incidence of wound complications. RESULTS Four hundred and one participants were enrolled and randomized, and 13 participants did not proceed with surgery or were lost to follow-up. High-risk features for infection were identified in 24% of the placebo group and 21% of the antibiotic group. Surgical site infections were more common in the placebo group (2.7% vs. 0.0%; p=0.025). The rate of contact dermatitis was similar (0.5% vs. 0.5%; p=1.00), as was the rate of wound dehiscence (2.7% vs. 3.6%; p=0.77). Among the placebo group, the incidence of infections in the low- and high-risk participants was 2.9% and 2.2%, respectively. Infections were treated with oral or topical antibiotics and resolved without complication, except in one case that required two subsequent surgeries to address the sequelae. CONCLUSION After routine oculofacial plastic surgery, patients treated with a topical antibiotic ointment had a lower risk of surgical site infection compared with patients treated with a non-antibiotic ointment.