LAUSR

performed to determine whether antibiotics were prescribed and whether any clinical signs of postoperative wound infection, such as localised swelling, tenderness, erythema or heat were present. A surgical site infection was determined to be present if it had been diagnosed by a clinician and if the clinical findings met the Centers for Disease Control and Prevention criteria for superficial surgical site infections. The prescriptions of antibiotics were assessed for their adherence with the Therapeutic Guidelines Limited and Western Australian Therapeutic Advisory Group guidelines. Altogether 128 patients underwent a skin biopsy in either the outpatient department or as an inpatient over the 2-month period. Of these 95% (n = 121) were reviewed postoperatively by the dermatology department, 4% (n = 5) of patients were reviewed by their general practitioner and 2% (n = 2) were lost to follow up. Pre-emptive treatment with cephalexin was prescribed in 6% (n = 8) of patients. The indications for pre-emptive treatment were not available in the medical records. Of the 121 patients reviewed postoperatively by the dermatology department, 4% (n = 5) developed a postoperative wound infection. All the infections were mild and did not require i.v. antibiotics or hospitalisation. Three patients were prescribed cephalexin empirically and one patient reported the resolution of the infection without antibiotics. The remaining patient had been treated pre-emptively with cephalexin and was commenced on flucloxacillin empirically. No antibiotic allergies were documented. The postoperative wound infection rate (4%) is in keeping with the documented rate for skin biopsies performed in Australia and other developed countries. It is also consistent with the accepted rate of infection following clean minor surgery of <5%. Antibiotic prescription for the empirical treatment of a postoperative wound infection was inconsistent with local guidelines, which recommend firstline flucloxacillin for patients without penicillin hypersensitivity. The appropriateness of the pre-emptive antibiotic prescriptions was difficult to assess as the indication for treatment was not available in the medical record. The Therapeutic Guidelines Limited and Western Australian Therapeutic Advisory Group guidelines do not recommend pre-emptive antibiotics for routine dermatology surgery except in defined circumstances where there are risk factors for postoperative infection, such as the implantation of prosthetic material or prior skin irradiation. The limitations of this study include a small sample size and the retrospective nature of the analysis. Due to the difficulties in differentiating between infection and inflammation the true infection rate is likely to be lower than the reported 4%. Although the rate of postoperative wound infection is within the accepted rates of infection following clean minor surgery, patients would benefit from interventions that may decrease the infection rate. Prescribing antibiotics that are consistent with local guidelines would also be of benefit. Due to the high volume of diagnostic skin biopsies performed in Australian dermatology departments a regular review of the rates of postoperative wound infection is important to improve quality and patient outcomes. This study provides an insight into current practices and the rates of postoperative wound infection in a major tertiary centre.