Postoperative Infections in Dermatologic Surgery: The Role of Wound Cultures.

BACKGROUND: Dermatologic surgery is associated with low postoperative infection rates, averaging from approximately 1% to 4.25%. Often, postoperative infections are treated empirically based on clinical diagnosis of infection, given it can take 48 to 72 hours for a wound culture to identify a pathogen. OBJECTIVE: We aimed to evaluate the efficacy of empiric antibiotics in dermatologic surgery postoperative infections and if wound cultures change postoperative antibiotic therapy. METHODS: A 7-center, retrospective analysis of postoperative infections, with culture data, in dermatologic surgery patients was performed. RESULTS: Of 91 cases of clinically diagnosed postoperative infection, 82.4% (n = 75) were successfully treated with empiric oral antibiotics (95% confidence interval [0.73-0.89], p < .0001). In 16 (17.6%) cases, initial empiric antibiotics were unsuccessful, and wound culture results altered antibiotic therapy in 9 cases (9.9%) with 6 (6.6%) of these cases requiring additional coverage for methicillin-resistant Staphylococcus aureus (MRSA). CONCLUSION: Empiric antibiotic treatment is usually appropriate for patients with postoperative surgical-site infections with wound cultures altering antibiotic management in a minority of cases. When empiric antibiotics fail, lack of MRSA coverage is usually the cause; therefore, providers should be aware of local MRSA prevalence and susceptibilities.

Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis.

OBJECTIVES/HYPOTHESIS: To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015. RESULTS: A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 ± 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M ± SD of 84.8 ± 8.4% (95% CI 82.8, 86.8) to 87.6 ± 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M ± SD of 20.4 ± 23.9 (95% CI 12.8, 28.0) to 4.0 ± 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M ± SD of 74.5 ± 11.9% (95% CI 70.9, 78.1) to 88.4 ± 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data). CONCLUSION: Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured. Laryngoscope, 126:1246-1255, 2016.

Skin therapies: dermatologic perspective on the rheumatology-dermatology interface.

Psoriasis is a common, chronic, inflammatory skin condition in which up to 42% of patients may develop psoriatic arthritis. Consequently, dermatologists and rheumatologists frequently manage the same patient for psoriasis and psoriatic arthritis, respectively. Hence, it is important for the two specialties to understand one another and work together to optimise care of patients with psoriatic disease. This article discusses several areas of clinical concern in which coordination of care is especially critical. First, when selecting a therapeutic modality, it is best to use treatments that improve both the joints and the skin, and exercise caution while using options that can rarely worsen the skin, such as systemic steroids. Second, a close working relationship between the two specialties is critical in making prompt and early diagnosis of psoriatic arthritis. Dermatologists often are on the frontlines for detecting early signs of joint involvement, and the prevalence of undiagnosed PsA among patients with psoriasis is estimated to be 15.5%. Third, in the rare instance of anti-TNF induced paradoxical worsening of the skin disease, it is highly recommended that these patients be referred to dermatologists as soon as possible for optimal management of the skin manifestations. Lastly, dermatologists in the US have a long history of undertreating generalised psoriasis, especially with regards to the use of systemic agents. Therefore, the consideration of systemic agents by the rheumatologist may greatly benefit the patient by treating both the joint and skin manifestations. In summary, this article highlights the importance of interdisciplinary coordination between rheumatologists and dermatologists for which both specialties offer unique and complementary expertise to the care of patients with psoriatic disease.