Abstract / Summary
Background/Objectives: Infection following skin grafting can compromise graft take and prolong hospitalisation, but contemporary data describing infection incidence, microbiology and graft-specific associations are limited. We aimed to determine the incidence and microbiology of microbiologically confirmed postoperative skin graft infection, examine associations with graft type and anatomical site and describe antimicrobial prescribing practices. Methods: We conducted a retrospective cohort study of 977 skin graft procedures performed in 770 patients at two regional hospitals in New South Wales, Australia, between July 2021 and August 2024. Infection was defined as a clinician-diagnosed postoperative skin graft infection with microbiological confirmation of a pathogenic organism. Associations between graft type/site and infection were explored using patient-clustered modified Poisson regression. Patient comorbidities and wound-contamination status were not consistently available and were not analysed as covariates. Results: A total of 66 microbiologically confirmed infections occurred among 977 procedures (6.8%; 95% CI 5.3–8.5%). Median length of stay was longer in infected than non-infected cases (34 vs. 3 days; p < 0.001). Split-thickness grafts involving the foot, toe and extensive granulating areas had higher observed infection incidence, while full-thickness nasal grafts had lower observed incidence; subgroup estimates were imprecise. Staphylococcus aureus (47.0%) and Pseudomonas aeruginosa (22.7%) were the predominant organisms. In the nested antimicrobial audit of 119 encounters involving 116 patients, peri-operative prophylaxis and postoperative antibiotic prescribing were common. Conclusions: This Australian cohort provides contemporary estimates of microbiologically confirmed infection following skin grafting and identifies graft type/site patterns that may inform future prospective investigation. Interpretation is limited by the retrospective design, microbiological confirmation requirement, sparse subgroup events and unavailable patient- and wound-level confounders; therefore, the observed associations should not be interpreted as independent risk factors or evidence for specific preventive or treatment strategies.