This retrospective study characterized gram-negative surgical site infections following Mohs micrographic surgery. The analysis identified common gram-negative pathogens, predisposing risk factors, and clinical presentations. The findings have implications for empiric antibiotic selection when gram-negative SSI is suspected, as standard prophylactic regimens targeting gram-positive organisms may be insufficient for certain wound locations.

Gram-negative SSIs after Mohs surgery are uncommon but may be underrecognized, particularly for lower extremity and groin wounds.

Empiric antibiotic selection should consider gram-negative coverage for infections not responding to standard gram-positive therapy.

Culture-directed therapy is essential for SSIs that fail to improve with initial empiric antibiotic treatment.