Antibiotic Prophylaxis for the Prevention of Surgical Site Infection after Tension-Free Hernia Repair: A Bayesian and Frequentist Meta-Analysis

Objective: The role of antibiotic prophylaxis (AP) in the prevention of surgical site infection (SSI) after hernia repair is debated. We conducted this systematic review and meta-analysis to assess the evidence on the value of prophylactic antibiotics in reducing the risks of SSI after open hernia surgery. Methods: We ran an online and manual search to identify relevant randomized controlled trials that compared prophylactic antibiotics to nonantibiotic controls in patients undergoing open surgical hernia repair. Data on SSI risk were extracted and pooled as risk ratios (RRs) with 95% confidence intervals (95% CIs), using RevMan software. We further used the Cochrane risk of bias tool and GRADE assessment to evaluate the quality of generated evidence. Results: Twenty-nine studies (N = 8,616 patients) were included in the current analysis. Antibiotic prophylaxis reduced the risk of SSI in open hernia repair patients (RR = 0.65, 95% CI = 0.53, 0.79). Subgroup analysis showed a significant benefit for antibiotics in mesh repair patients (RR = 0.60, 95% CI = 0.48, 0.76) yet no significant difference in SSI risk after herniorrhaphy (RR = 0.86, 95% CI = 0.54, 1.36). In addition, AP was associated with a significant reduction in superficial SSI risk (RR = 0.56, 95% CI = 0.43, 0.72) but not deep SSI (RR = 0.70, 95% CI = 0.30, 1.62). Further analysis showed a significant reduction in SSI risk with amoxicillin/clavulanic acid and cefazolin but not with cefuroxime. Conclusion: The present meta-analysis suggests that AP is beneficial prior to open mesh hernia repair. However, the quality of evidence was low, and further well-designed trials are needed.

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Effect of single dose pre-operative antibiotic prophylaxis versus conventional antibiotic therapy in patients undergoing lichtenstein tension free mesh repair

International Surgery Journal ◽

10.18203/2349-2902.isj20170224 ◽

2017 ◽

Vol 4 (2) ◽

pp. 738

Author(s):

Madhu B. S. ◽

Shashi Kumar H. B. ◽

Naveen Kumar Reddy M. ◽

Abilash V. Reddy ◽

Sangeetha Kalabhairav

Keyword(s):

Single Dose ◽

Inguinal Hernia ◽

Side Effects ◽

Hernia Repair ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Mesh Repair ◽

Control Group ◽

Site Infection ◽

Tension Free

Background: Rational use of antibiotic is important as injudicious use can adversely affect the patient, cause emergence of antibiotic resistance and increase the cost of health care. The efficacy of antibiotic prophylaxis in preventing surgical site infection in patients undergoing Lichtenstein tension free inguinal hernia repair still remains controversial.Methods: A randomized controlled trial was conducted in patients undergoing lichtenstein tension free inguinal hernia repair between January 2015 to June 2016, and the results were compared with the control group in whom, conventional antibiotics were given for 7 days . All patients in study group undergoing surgery were given 400 mg parenteral ciprofloxacin 30 min prior to surgery. In the control group, the patients were given 2 days parenteral ciprofloxacin 400 mg twice a day and the next 5 days the same antibiotics were given in oral route, after surgery. Total 100 patients were randomized to 50 each group. The outcome in terms of duration of surgery, surgical site infection, cost and antibiotic side effects were then compared.Results: The duration of the hospital stay, cost and side effects are significantly higher in the control group patients. Antibiotic side effects (P < 0.05) were high for control group. The infection rate was same in both the groups. There was no significant difference in terms of infection rate among two groups.Conclusions: This study concludes that prophylactic single-dose antibiotic is effective in preventing surgical site infection and is cost-effective in patients undergoing lichtenstein tension free mesh repair.

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Antibiotic Prophylaxis in Patients Undergoing Open Mesh Repair of Inguinal Hernia: A Meta-Analysis

The American Surgeon ◽

10.1177/000313481207800348 ◽

2012 ◽

Vol 78 (3) ◽

pp. 359-365 ◽

Cited By ~ 12

Author(s):

Yuan Yin ◽

Turun Song ◽

Banghua Liao ◽

Qian Luo ◽

Zongguang Zhou

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Mesh Repair ◽

Meta Analysis ◽

Controlled Trials ◽

Site Infection ◽

Open Mesh Repair ◽

Open Mesh

The use of antibiotic prophylaxis in hernia repair is still under debate. The aim of this meta-analysis was to assess the effect of antibiotic prophylaxis in patients undergoing open mesh repair of inguinal hernia with respect to incidence of postoperative surgical site infection (SSI). A literature search was conducted in databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Study selection, data extraction, quality assessment, and meta-analysis were conducted according to the recommendations by Cochrane collaboration. Nine randomized controlled trials were included. Incidence of surgical site infection was 39/1642 (2.38%) in the antibiotic group and 70/1676 (4.18%) in the control group. Antibiotics showed a protective effect in preventing SSI after mesh inguinal hernia repair (odds ratio: 0.61, 95% confidence interval: 0.40–0.92, I2: 0%). Antibiotic prophylaxis did reduce the incidence of SSI in hernia patients undergoing mesh hernioplasty. The cost effectiveness of antibiotic prophylaxis needs further evaluation.

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EP.TH.747Audit of antibiotic prophylaxis in groin hernia repair

British Journal of Surgery ◽

10.1093/bjs/znab309.080 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Maitreyi Patel ◽

Aleem O'Balogun ◽

Naveed Kirmani

Keyword(s):

Hernia Repair ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Groin Hernia ◽

Open Repair ◽

Risk Category ◽

Site Infection ◽

Groin Hernia Repair ◽

Hernia Surgery ◽

International Guidelines

Abstract Aims To review practice of antibiotic prophylaxis in patients undergoing groin hernia repair against the International guidelines for groin hernia management 2018, in order to improve compliance with International Guidelines. We also assessed the risk category of patients. Methods Retrospective data of all patients undergoing groin hernia repair from November 2019 to March 2020 was collected using hospital software. Data collected included patient demographics, details of hernia repair including; primary/recurrent hernia, emergency/elective, laparoscopic/open repair and use of mesh. The details of antibiotic prophylaxis were recorded. Descriptive statistics was used. Data was analyzed using Microsoft Excel. Results 67 patients were included, of which 38(57%) were high risk. 62 (92.5%) primary repairs were done, of which 48(72%) were open. 62(92.5%) were operated electively. 46(69%) patients underwent open repair with mesh, 6(9%) had open repair without mesh, while 15(22%) had laparoscopic repair with mesh. A total of 45 (67%) patient received antibiotic prophylaxis. Adherence to International guidelines for groin hernia in open hernia surgery was 82.67%, while that for laparoscopic surgery was 60%. Overall adherence to the Guidelines was 56.67%. Conclusions The audit reflects the need for improved understanding and adherence to the International Guidelines. Data collection of surgical site infection can help inform and influence practice to minimize the risk for surgical site infection and assist in better communication with patients regarding risk. Risk assessment for surgical site infection of patients prior to procedure helps to identify those with indication of antibiotic prophylaxis.

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Interventions to reduce the incidence of surgical site infection in colorectal resections: systematic review with multicomponent network meta-analysis (INTRISSI): study protocol

BMJ Open ◽

10.1136/bmjopen-2021-057226 ◽

2021 ◽

Vol 11 (11) ◽

pp. e057226

Author(s):

Juliane Friedrichs ◽

Svenja Seide ◽

Johannes Vey ◽

Samuel Zimmermann ◽

Julia Hardt ◽

...

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Bowel Preparation ◽

Meta Analysis ◽

Mechanical Bowel Preparation ◽

Supervised Machine Learning ◽

Controlled Trials ◽

Site Infection ◽

Oral Antibiotics ◽

Colorectal Resections

ObjectiveTo assess the relative contribution of intravenous antibiotic prophylaxis, mechanical bowel preparation, oral antibiotic prophylaxis, and combinations thereof towards the reduction of surgical site infection (SSI) incidence in elective colorectal resections.Methods and analysisA systematic search of randomised controlled trials comparing interventions to reduce SSI incidence will be conducted with predefined search terms in the following databases: MEDLINE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Additionally, several online databases will be searched for ongoing trials, and conference proceedings and reference lists of retrieved articles will be hand searched. The title–abstract screening will be partly performed by means of a semiautomated supervised machine learning approach, which will be trained on a subset of the identified titles and abstracts identified through traditional screening methods.The primary analysis will be a multicomponent network meta-analysis, as we expect to identify studies that investigate combinations of interventions (eg, mechanical bowel preparation combined with oral antibiotics) as well as studies that focus on individual components (mechanical bowel preparation or oral antibiotics). By means of a multicomponent network meta-analysis, we aim at estimating the effects of the separate components along the effects of the observed combinations. To account for between-trial heterogeneity, a random-effect approach will be combined with inverse variance weighting for estimation of the treatment effects. Associated 95% CIs will be calculated as well as the ranking for each component in the network using P scores. Results will be visualised by network graphics and forest plots of the overall pairwise effect estimates. Comparison-adjusted funnel plots will be used to assess publication bias.Ethics and disseminationEthical approval by the Ethical Committee of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg (ID of approval: 2021–148). Results shall be disseminated directly to decision-makers (eg, surgeons, gastroenterologists, wound care specialists) by means of publication in peer-reviewed journals, presentation at conferences and through the media (eg, radio, TV, etc).PROSPERO registration numberCRD42021267322.

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Long-term antibiotic prophylaxis regimen compared to short-term antibiotic prophylaxis regimen in patients undergoing orthognathic surgery

Medwave ◽

10.5867/medwave.2020.11.8071 ◽

2020 ◽

Vol 20 (11) ◽

pp. e8071-e8071

Author(s):

Matthias Wallach ◽

Javier Cuéllar ◽

Francisca Verdugo-Paiva ◽

Ana Alarcón

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Systematic Reviews ◽

Orthognathic Surgery ◽

Meta Analysis ◽

Prophylactic Antibiotic ◽

Cost Benefit ◽

Site Infection ◽

Short Term

INTRODUCTION Orthognathic surgery, being an invasive surgical procedure, may present significant postoperative morbidities for the patient. Among the most frequently described complications is surgical site infection. The administration of prophylactic antibiotics prior to this type of procedure is a common practice, however, the cost-benefit of the use of antibiotics, the type of antibiotics, the route of administration, the dosage, and the regimen to be used have not been clearly defined and are still considered a controversial issue. In this summary of evidence, we will compare long-term antibiotic prophylaxis with short-term prophylaxis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews including nine studies overall, of which all nine were randomized trials. We conclude that administering a long-term prophylactic antibiotic regimen probably decreases the risk of surgical site infection and that it may increase the risk of hospital stay longer than two days, nevertheless, regarding this last point, the certainty of the evidence is low.

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