Current prescription trends in antibiotic prophylaxis: a multinational survey in esthetic plastic surgery.

Background: Surgical site infections pose a significant challenge in esthetic surgery, representing one of the most prevalent complications. While research in plastic surgery remains limited, reported rates of SSI range from 0.5% to 32.6%. Although the overall incidence of infections in most esthetic surgeries is low, it carries a significant burden of morbidity, hospital readmissions, and prolonged hospital stays.

Purpose: Our study aims to provide evidence-based recommendations regarding the prescription of prophylactic antibiotics for the most common esthetic plastic surgery procedures, based on current trends among plastic surgeons.

Methods: An anonymous online survey was conducted among board-certified plastic surgeons to assess antibiotic prophylaxis practices. The survey was distributed via individual links on social media, plastic surgery society platforms, and private surgeon groups. Responses were recorded between February and April 2022 and were available in three different languages: English, Portuguese, and Spanish. The questionnaire covered eight common esthetic procedures, evaluating antibiotic use (prophylactic and non-prophylactic), duration, and type prescribed.

Results: Our study analyzed data from 2216 plastic surgery procedures, with 277 respondents answering each of the three questions per procedure. Cephalosporins were the most commonly prescribed antibiotics (73.3%), followed by quinolones (12.9%). Antibiotic therapy exceeded 5 days in 39.6% of cases, while 32.3% reported a 5-day duration. Single-dose prophylaxis was used in only 12% of cases.

Conclusion: The rise of multidrug-resistant microorganisms is a growing global concern. Despite established guidelines on antibiotic prophylaxis, misuse among surgeons persists. Our findings highlight the urgent need for stricter antimicrobial stewardship, ensuring that antibiotics are prescribed only when clinically indicated.

Level of evidence: III. Type of Study: Cross-Sectional, Observational Survey Study.