Abstract
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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References
1.
World Health Organization
. Surgical site infections
; 2020
.2.
Daniels
IR
, Smart
NJ
. In support of mesh for hernia repair
. Br J Surg
. 2019
;106
(7
):815
–6
.3.
Tubre
DJ
, Schroeder
AD
, Estes
J
, Eisenga
J
, Fitzgibbons
RJ
. Surgical site infection: the “Achilles Heel” of all types of abdominal wall hernia reconstruction
. Hernia
. 2018
;22
(6
):1003
–13
.4.
Ashrafi
D
, Siddaiah-Subramanya
M
, Memon
B
, Memon
MA
. Causes of recurrences after open inguinal herniorrhaphy
. Hernia
. 2019
;23
(4
):637
–45
.5.
Kark
AE
, Kurzer
MN
, Belsham
PA
. Three thousand one hundred seventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia
. J Am Coll Surg
. 1998
;186
(4
):447
–56
.6.
Gilbert
AI
, Felton
LL
. Infection in inguinal hernia repair considering biomaterials and antibiotics
. Surg Gynecol Obstet
. 1993
;177
(2
):126
.7.
Bailey
IS
, Karran
SE
, Toyn
K
, Brough
P
, Ranaboldo
C
, Karran
SJ
. Community surveillance of complications after hernia surgery
. BMJ
. 1992
;304
(6825
):469
–71
.8.
HerniaSurge Group
. International guidelines for groin hernia management
. Hernia
. 2018
;22
(1
):1
165
.9.
Platt
R
, Zaleznik
DF
, Hopkins
CC
, Dellinger
EP
, Karchmer
AW
, Bryan
CS
, . Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery
. N Engl J Med
. 1990
;322
(3
):153
–60
.10.
Taylor
EW
, Byrne
DJ
, Leaper
DJ
, Karran
SJ
, Browne
MK
, Mitchell
KJ
. Antibiotic prophylaxis and open groin hernia repair
. World J Surg
. 1997
;21
(8
):811
–5
.11.
Morales
R
, Carmona
A
, Pagán
A
, García-Menéndez
C
, Bravo
R
, Hernández
M
, . Utilidad de la profilaxis antibiótica en la reducción de la infección de herida en la reparación de la hernia inguinal o crural mediante malla de polipropileno
. Cir Esp
. 2000
;67
(1
):51
9
.12.
Yerdel
MA
, Akin
EB
, Dolalan
S
, Turkcapar
AG
, Pehlivan
M
, Gecim
IE
, . Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial
. Ann Surg
. 2001
;233
(1
):26
.13.
Aufenacker
TJ
, van Geldere
D
, Van Mesdag
T
, Bossers
AN
, Dekker
B
, Scheijde
E
, . The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia: a multicenter double-blind randomized controlled trial
. Ann Surg
. 2004
;240
(6
):955
–1
.14.
Celdrán
A
, Frieyro
O
, de la Pinta
JC
, Souto
JL
, Esteban
J
, Rubio
JM
, . The role of antibiotic prophylaxis on wound infection after mesh hernia repair under local anesthesia on an ambulatory basis
. Hernia
. 2004
;8
(1
):20
–2
.15.
Oteiza
F
, Ángel Ciga
M
, Ortiz
H
. Profilaxis antibiótica en la hernioplastia inguinal
. Cirugía Española
. 2004
;75
(2
):69
–71
.16.
Perez
AR
, Roxas
MF
, Hilvano
SS
. A randomized, double-blind, placebo-controlled trial to determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy
. J Am Coll Surg
. 2005
;200
(3
):393
–8
.17.
Terzi
C
, Kiliç
D
, Ünek
T
, Hoşgörler
F
, Füzün
M
, Ergör
G
. Single-dose oral ciprofloxacin compared with single-dose intravenous cefazolin for prophylaxis in inguinal hernia repair: a controlled randomized clinical study
. J Hosp Infect
. 2005
;60
(4
):340
–7
.18.
Tzovaras
G
, Delikoukos
S
, Christodoulides
G
, Spyridakis
M
, Mantzos
F
, Tepetes
K
, . The role of antibiotic prophylaxis in elective tension-free mesh inguinal hernia repair: results of a single-centre prospective randomised trial
. Int J Clin Prac
. 2007
;61
(2
):236
–9
.19.
Jain
SK
, Jayant
M
, Norbu
C
. The role of antibiotic prophylaxis in mesh repair of primary inguinal hernias using prolene hernia system: a randomized prospective double-blind control trial
. Trop Doct
. 2008
;38
(2
):80
–2
.20.
Shankar
VG
, Srinivasan
K
, Sistla
SC
, Jagdish
S
. Prophylactic antibiotics in open mesh repair of inguinal hernia: a randomized controlled trial
. Int J Surg
. 2010
;8
(6
):444
–7
.21.
Thakur
L
, Upadhyay
S
, Peters
NJ
, Saini
N
, Deodhar
M
. Prophylactic antibiotic usage in patients undergoing inguinal mesh hernioplasty: a clinical study
. Indian J Surg
. 2010
;72
(3
):240
–2
.22.
Goyal
A
, Garg
R
, Jenaw
RK
, Jindal
DK
. Role of prophylactic antibiotics in open inguinal hernia repair: a randomised study
. Indian J Surg
. 2011
;73
(3
):190
–3
.23.
Othman
I
. Prospective randomized evaluation of prophylactic antibiotic usage in patients undergoing tension free inguinal hernioplasty
. Hernia
. 2011
;15
(3
):309
–13
.24.
Ergul
Z
, Akinci
M
, Ugurlu
C
, Kulacoglu
H
, Yilmaz
KB
. Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center
. Hernia
. 2012
;16
(2
):145
–51
.25.
Ullah
B
, Khan
SA
, Ahmed
S
, Pasha
T
. Efficacy of preoperative single dose antibiotic in patients undergoing mesh repair for inguinal hernia
. J Ayub Med Coll Abbottabad
. 2013
;25
(1–2
):103
–5
.26.
Wang
J
, Ji
G
, Yang
Z
, Xi
M
, Wu
Y
, Zhao
P
, . Prospective randomized, double-blind, placebo controlled trial to evaluate infection prevention in adult patients after tension-free inguinal hernia repair
. Int J Clin Pharmacol Ther
. 2013
;51
(12
):924
–31
.27.
Mazaki
T
, Mado
K
, Masuda
H
, Shiono
M
, Tochikura
N
, Kaburagi
M
. A randomized trial of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia repair
. Am J Surg
. 2014
;207
(4
):476
–84
.28.
Abd Al-Fatah
M
. The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein repair of primary inguinal hernia
. Al-Azhar Assiut Med J
. 2011
;9
:173
–80
.29.
Kochhar
G
, Andley
M
, Saha
S
, Kumar
A
, Saurabh
G
, Kumar
A
, . Randomized controlled trial to evaluate the role of antibiotic prophylaxis in lichtenstein hernia repair
. J Young Med Res
. 2014
;1
(2
):1
–8
.30.
Akhtar
K
, Khan
Z
, Bhatti
AM
, Mahmood
K
. Impact of using prophylactic antibiotic on prevention of wound infection in inguinal herniorrhaphy
. Pak Armed Forces Med J
. 2015
;65
(4
):453
–7
.31.
Razack
A
, Kapoor
KK
, Tambat
RM
. The role of single dose antibiotic prophylaxis in open mesh repair of inguinal hernia: a prospective, double blind randomized trial
. J Evol Med Dent Sci
. 2015
;4
(35
):6017
–27
.32.
Bahar
MM
, Nooghabi
AJ
, Nooghabi
MJ
, Jangjoo
A
. The role of prophylactic cefazolin in the prevention of infection after various types of abdominal wall hernia repair with mesh
. Asian J Surg
. 2015
;38
(3
):139
–44
.33.
Rahmani
N
, Sarav
K
, Sayadi
M
, Khalilia
A
. Effect of prophylactic antibiotics in preventing wound infection in hernioplasty with inguinal mesh in Lichtenstein method
. J Mazandaran Univ Med Sci
. 2012
;22
(90
):88
–93
.34.
Vinoth
N
, Karthikeyan
CRM
, Parmar
H
. Role of antibiotic prophylaxis in open inguinal hernioplasty: a prospective randomized clinical trial
. Int Arch Integ Med
. 2015
;2
(3
):57
–67
.35.
Siddiqui
MAR
, Aleem
MA
, Rahman
MS
, Zafreen
F
. Role of prophylactic antibiotics in open mesh inguinal hernia repair
. J Armed Forces Med Coll
. 2019
;13
(2
):18
–21
.36.
Bidar
KC
, Regmi
R
, Agarwal
CS
, Pathania
OP
. Role of single dose antibiotic prophylaxis in prevention of wound infection following lichtenstein inguinal hernioplasty: a randomized clinical trial
. Nepal J Med Sci
. 2013
;2
(2
):108
–13
.37.
Kahla
S
, Gaber
A
, Al-Rahawy
M
. The role of antibiotic prophylaxis in the prevention of surgical- site infection after hernioplasty in Menoufia University Hospital
. Menoufia Med J
. 2019
;32
(3
):1137
–41
.38.
Higgins
JP
, Thomas
J
, Chandler
J
, Cumpston
M
, Li
T
, Page
M
, . Cochrane handbook for systematic reviews of interventions
. John Wiley & Sons
; 2019
.39.
Moher
D
, Liberati
A
, Tetzlaff
J
, Altman
DG
. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
. BMJ
. 2009
;339
(7
):b2535
.40.
Higgins
JP
, Altman
DG
, Gøtzsche
PC
, Jüni
P
, Moher
D
, Oxman
AD
, . The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials
. BMJ
. 2011
;343
:d5928
.41.
Schünemann
HJ
, Oxman
AD
, Brozek
J
, Glasziou
P
, Bossuyt
P
, Chang
S
, . GRADE: assessing the quality of evidence for diagnostic recommendations
. Evid Based Med
. 2008
;13
(6
):162
–3
.42.
Li
JF
, Lai
DD
, Zhang
XD
, Zhang
AM
, Sun
KX
, Luo
HG
, . Meta-analysis of the effectiveness of prophylactic antibiotics in the prevention of postoperative complications after tension-free hernioplasty
. Can J Surg
. 2012
;55
(1
):27
.43.
Sanchez-Manuel
FJ
, Seco-Gil
JL
. Antibiotic prophylaxis for hernia repair
. Cochrane Database Syst Rev
. 2004
;4
:CD003769
.44.
Sanabria
A
, Domínguez
LC
, Valdivieso
E
, Gómez
G
. Prophylactic antibiotics for mesh inguinal hernioplasty: a meta-analysis
. Ann Surg
. 2007
;245
(3
):392
.45.
Yin
Y
, Song
T
, Liao
B
, Luo
Q
, Zhou
Z
. Antibiotic prophylaxis in patients undergoing open mesh repair of inguinal hernia: a meta-analysis
. Am Surg
. 2012
;78
(3
):359
–65
.46.
Aufenacker
TJ
, Koelemay
MJ
, Gouma
DJ
, Simons
MP
. Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia
. Br J Surg
. 2006
;93
(1
):5
–10
.47.
Erdas
E
, Medas
F
, Pisano
G
, Nicolosi
A
, Calò
PG
. Antibiotic prophylaxis for open mesh repair of groin hernia: systematic review and meta-analysis
. Hernia
. 2016
;20
(6
):765
–76
.48.
Mazaki
T
, Mado
K
, Masuda
H
, Shiono
M
. Antibiotic prophylaxis for the prevention of surgical site infection after tension-free hernia repair: a Bayesian and frequentist meta-analysis
. J Am Coll Surg
. 2013
;217
(5
):788
–4
.49.
Boonchan
T
, Wilasrusmee
C
, McEvoy
M
, Attia
J
, Thakkinstian
A
. Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery
. Br J Surg
. 2017
;104
(2
):e106
.50.
Just
E
, Botet
X
, Martínez
S
, Escolà
D
, Moreno
I
, Duque
E
. Reduction of the complication rate in Liechtenstein hernia repair
. Int J Surg
. 2010
;8
(6
):462
–5
.51.
Taylor
EW
, Duffy
K
, Lee
K
, Hill
R
, Noone
A
, Macintyre
I
, . Surgical site infection after groin hernia repair
. Br J Surg
. 2004
;91
(1
):105
–11
.52.
Riley
KD
, Lilly
MC
, Arregui
ME
. Management of complications following inguinal hernia repair
. Probl Gen Surg
. 2002
;19
(4
):97
–108
.53.
Glassow
F
. Is postoperative wound infection following simple inguinal herniorrhaphy a predisposing cause of recurrent hernia
. Can Med Assoc J
. 1964
;91
(16
):870
–1
.54.
Davey
PG
, Nathwani
D
. What is the value of preventing postoperative infections
. New Horiz
. 1998
;6
(2 Suppl l
):S64
–71
.55.
Weed
HG
. Antimicrobial prophylaxis in the surgical patient
. Med Clin North Am
. 2003
;87
(1
):59
–75
.56.
World Health Organization
. Protocol for surgical site infection surveillance with a focus on settings with limited resources
. 2018
. Available from: https://www.who.int/infection-prevention/tools/surgical/SSI- surveillance-protocol.pdf?ua=1 Accessed 2020 Aug 20.© 2021 S. Karger AG, Basel
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