Biologic therapies did not increase postoperative skin, soft tissue infection risk

Biologic therapies did not put individuals undergoing surgery at greater risk for post-operative skin and soft tissue infections, according to a study.

“Biologic agents may predispose patients to skin and soft tissue infections (SSTIs),” Emily D. Nguyen, MD, of the department of dermatology at Massachusetts General Hospital, and colleagues wrote.

While recommendation documents favor the discontinuation of biologics in the preoperative setting, there is uncertainty about their true infection risk.

In the retrospective cross-sectional study, Nguyen and colleagues aimed to evaluate the incidence of SSTIs for biologics not only in the surgical setting, but for all clinical indications.

Findings for four medications were assessed, including adalimumab (Humira, Abbvie), infliximab (Remicade, Janssen), etanercept (Enbrel, Amgen) and ustekinumab (Stelara, Janssen).

Data from two urban tertiary care hospitals for patients treated with biologics between June 2013 and June 2018 were used in the analysis.

Results showed no association between biologic use and SSTI risk. However, when biologics were used concomitantly with corticosteroids, risk for these infections was elevated (P = .0049).

Factors associated with SSTIs included hypertension, former smoking and corticosteroid use (P < .05), according to the findings.

When the researchers looked at patients who stopped biologics before surgery versus those who did not, they found no significant difference in postoperative risk for SSTIs.

Regarding the timing of biologic cessation, the researchers observed no significant elevation in infection risk when biologics were stopped three half-lives before the procedure, three to five half-lives before the procedure or more than five half-lives before the procedure.

There were 218 surgeries among 180 patients that underwent analysis. Specific procedure carried an association with postoperative risk for SSTIs (P = .029). These infections occurred in 33.3% of breast surgeries, 16.9% of abdominal surgeries and 11.1% of neurosurgeries.

The retrospective design may limit this analysis.

“Our study shows no relationship between the four biologic agents studied and risk of postoperative SSTI,” the researchers concluded. “These data are an important step in further elucidating the relationship between biologic agents and SSTIs.”

It was also suggested that current guidelines pertaining to biologic cessation in the surgical setting warrant further review.