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Published in: Hernia 2/2012

01-04-2012 | Original Article

Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center

Authors: Z. Ergul, M. Akinci, C. Ugurlu, H. Kulacoglu, K. B. Yilmaz

Published in: Hernia | Issue 2/2012

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Abstract

Purpose

In this double-blind prospective randomized trial, our objective was to investigate the effect of antibiotic prophylaxis in patients undergoing elective inguinal hernia surgery with mesh repair in a large-volume tertiary referral trauma center.

Methods

Eligible patients were assigned randomly to either an antibiotic prophylaxis group or a control group. Patients in the prophylaxis group were given 1 g cefazolin by IV bolus injection whereas the placebo control group received an equal volume of sterile saline preoperatively. A Lichtenstein repair was done in all cases. The patients were examined for surgical site infection (SSI) and other postoperative local complications before discharge, and reexamined 3, 5, 7, and 30 days after discharge.

Results

Groups were well matched for age, sex, coexisting diseases, ASA scores, type of hernia, type of anesthesia, duration of surgery. Incidence of infection was 7% in the control group (7/100) and 5% in the prophylaxis group (5/100) (P = 0.38). All the infections were superficial and responded well to drainage and proper antibiotic therapy. All other postoperative complications were similar in the two groups.

Conclusions

In our settings antibiotic prophylaxis has no significant effect on the incidence of SSI in elective repair of inguinal hernias with mesh. The most effective way to reduce the incidence of infection in prosthetic repair may be a specific center for treatment of abdominal wall hernias.
Literature
1.
go back to reference Sanchez-Manuel FJ, Seco-Gil JL (2004) Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev (4):CD003769 Sanchez-Manuel FJ, Seco-Gil JL (2004) Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev (4):CD003769
2.
go back to reference Sanchez-Manuel FJ, Lozano-García J, Seco-Gil JL (2007) Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev (3):CD003769 Sanchez-Manuel FJ, Lozano-García J, Seco-Gil JL (2007) Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev (3):CD003769
3.
go back to reference Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403PubMedCrossRef Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403PubMedCrossRef
4.
go back to reference Cingi A, Manukyan MN, Güllüoğlu BM, Barlas A, Yeğen C, Yalin R, Yilmaz N, Aktan AO (2005) Use of resterilized polypropylene mesh in inguinal hernia repair: a prospective, randomized study. J Am Coll Surg 201:834–840PubMedCrossRef Cingi A, Manukyan MN, Güllüoğlu BM, Barlas A, Yeğen C, Yalin R, Yilmaz N, Aktan AO (2005) Use of resterilized polypropylene mesh in inguinal hernia repair: a prospective, randomized study. J Am Coll Surg 201:834–840PubMedCrossRef
5.
go back to reference Yerdel MA, Akin EB, Dolalan S, Turkcapar AG, Pehlivan M, Gecim IE, Kuterdem E (2001) 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 233:26–33PubMedCrossRef Yerdel MA, Akin EB, Dolalan S, Turkcapar AG, Pehlivan M, Gecim IE, Kuterdem E (2001) 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 233:26–33PubMedCrossRef
6.
go back to reference Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20:271–274PubMedCrossRef Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20:271–274PubMedCrossRef
7.
go back to reference Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol 20:250–280PubMedCrossRef Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol 20:250–280PubMedCrossRef
8.
go back to reference Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P, Juul P, Callesen T, Danish Hernia Database Collaboration (2001) Quality assessment of 26, 304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358:1124–1128PubMedCrossRef Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P, Juul P, Callesen T, Danish Hernia Database Collaboration (2001) Quality assessment of 26, 304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358:1124–1128PubMedCrossRef
9.
go back to reference Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O’Dwyer PJ (2000) Groin hernia repair in Scotland. Br J Surg 87:1722–1726PubMedCrossRef Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O’Dwyer PJ (2000) Groin hernia repair in Scotland. Br J Surg 87:1722–1726PubMedCrossRef
10.
go back to reference EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235:322–332CrossRef EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235:322–332CrossRef
11.
go back to reference Hill C, Flamant R, Mazas F, Evrard J (1981) Prophylactic cefazolin versus placebo in total hip replacement. Lancet 1:795–796PubMedCrossRef Hill C, Flamant R, Mazas F, Evrard J (1981) Prophylactic cefazolin versus placebo in total hip replacement. Lancet 1:795–796PubMedCrossRef
12.
go back to reference Kaiser AB, Petracek MR, Lea JV (1987) Efficacy of cefazolin, cefamandole and gentamicin as prophylactic agents in cardiac surgery: results of a prospective, randomized, double-blind trial in 1030 patients. Ann Surg 206:791–797PubMedCrossRef Kaiser AB, Petracek MR, Lea JV (1987) Efficacy of cefazolin, cefamandole and gentamicin as prophylactic agents in cardiac surgery: results of a prospective, randomized, double-blind trial in 1030 patients. Ann Surg 206:791–797PubMedCrossRef
13.
go back to reference Taylor EW, Duffy K, Lee K, Hill R, Noone A, Macintyre I, King PM, O’Dwyer PJ (2004) Surgical site infection after groin hernia repair. Br J Surg 91:105–111PubMedCrossRef Taylor EW, Duffy K, Lee K, Hill R, Noone A, Macintyre I, King PM, O’Dwyer PJ (2004) Surgical site infection after groin hernia repair. Br J Surg 91:105–111PubMedCrossRef
14.
go back to reference Terzi C (2006) Antimicrobial prophylaxis in clean surgery with special focus on inguinal hernia repair with mesh. J Hosp Infect 62:427–436PubMedCrossRef Terzi C (2006) Antimicrobial prophylaxis in clean surgery with special focus on inguinal hernia repair with mesh. J Hosp Infect 62:427–436PubMedCrossRef
15.
go back to reference Morales R, Carmona A, Paga′n A (2000) Utilidad de la profilaxis antibio′tica en la reduccio′n de la infeccio′n de herida en la reparacio′n de la hernia inguinal o crural mediante malla de prolipropileno [utility of antibiotic prophylaxis in reducing wound infection in inguinal or femoral hernia repair using polypropylene mesh]. Cir Esp 67:51–59 Morales R, Carmona A, Paga′n A (2000) Utilidad de la profilaxis antibio′tica en la reduccio′n de la infeccio′n de herida en la reparacio′n de la hernia inguinal o crural mediante malla de prolipropileno [utility of antibiotic prophylaxis in reducing wound infection in inguinal or femoral hernia repair using polypropylene mesh]. Cir Esp 67:51–59
16.
go back to reference Aufenacker TJ, van Geldere D, van Mesdag T, Bossers AN, Dekker B, Scheijde E, van Nieuwenhuizen R, Hiemstra E, Maduro JH, Juttmann JW, Hofstede D, van Der Linden CT, Gouma DJ, Simons MP (2004) 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 240:955–961PubMedCrossRef Aufenacker TJ, van Geldere D, van Mesdag T, Bossers AN, Dekker B, Scheijde E, van Nieuwenhuizen R, Hiemstra E, Maduro JH, Juttmann JW, Hofstede D, van Der Linden CT, Gouma DJ, Simons MP (2004) 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 240:955–961PubMedCrossRef
17.
go back to reference Celdrán A, Frieyro O, de la Pinta JC, Souto JL, Esteban J, Rubio JM, Señarís JF (2004) The role of antibiotic prophylaxis on wound infection after mesh hernia repair under local anesthesia on an ambulatory basis. Hernia 8:20–22PubMedCrossRef Celdrán A, Frieyro O, de la Pinta JC, Souto JL, Esteban J, Rubio JM, Señarís JF (2004) The role of antibiotic prophylaxis on wound infection after mesh hernia repair under local anesthesia on an ambulatory basis. Hernia 8:20–22PubMedCrossRef
18.
go back to reference Perez AR, Roxas MF, Hilvano SS (2005) A randomized, double-blind, placebo-controlled trial to determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy. J Am Coll Surg 200:393–398PubMedCrossRef Perez AR, Roxas MF, Hilvano SS (2005) A randomized, double-blind, placebo-controlled trial to determine effectiveness of antibiotic prophylaxis for tension-free mesh herniorrhaphy. J Am Coll Surg 200:393–398PubMedCrossRef
19.
go back to reference Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH (1993) Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 128:79–88PubMedCrossRef Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH (1993) Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 128:79–88PubMedCrossRef
20.
go back to reference Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE Jr, Sweet RL, Wenzel RP (1994) Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis 18:422–427PubMedCrossRef Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE Jr, Sweet RL, Wenzel RP (1994) Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis 18:422–427PubMedCrossRef
21.
go back to reference Woods RK, Dellinger EP (1998) Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 57(11):2731–2740PubMed Woods RK, Dellinger EP (1998) Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 57(11):2731–2740PubMed
22.
go back to reference Waldvogel FA, Vaudaux PE, Pittet D, Lew PD (1991) Perioperative antibiotic prophylaxis of wound and foreign body infections: microbial factors affecting efficacy. Rev Infect Dis 13:782–789CrossRef Waldvogel FA, Vaudaux PE, Pittet D, Lew PD (1991) Perioperative antibiotic prophylaxis of wound and foreign body infections: microbial factors affecting efficacy. Rev Infect Dis 13:782–789CrossRef
23.
go back to reference Taylor EW, Byrne DJ, Leaper DJ, Karran SJ, Browne MK, Mitchell KJ (1997) Antibiotic prophylaxis and open groin hernia repair. World J Surg 21:811–815PubMedCrossRef Taylor EW, Byrne DJ, Leaper DJ, Karran SJ, Browne MK, Mitchell KJ (1997) Antibiotic prophylaxis and open groin hernia repair. World J Surg 21:811–815PubMedCrossRef
24.
go back to reference Bailey IS, Karran SE, Toyn K, Brough P, Ranaboldo C, Karran SJ (1992) Community surveillance of complications after hernia surgery. BMJ 304:469–471PubMedCrossRef Bailey IS, Karran SE, Toyn K, Brough P, Ranaboldo C, Karran SJ (1992) Community surveillance of complications after hernia surgery. BMJ 304:469–471PubMedCrossRef
25.
go back to reference Santos KRN, Neto GPB, Fonseca LS, Filho PPG (1997) Incidence surveillance of wound infection in hernia surgery during hospitalization and after discharge in a university hospital. J Hosp Infect 36:229–233PubMedCrossRef Santos KRN, Neto GPB, Fonseca LS, Filho PPG (1997) Incidence surveillance of wound infection in hernia surgery during hospitalization and after discharge in a university hospital. J Hosp Infect 36:229–233PubMedCrossRef
26.
go back to reference Shankar VG, Srinivasan K, Sistla SC, Jagdish S (2010) Prophylactic antibiotics in open mesh repair of inguinal hernia—a randomized controlled trial. Int J Surg 8:444–447PubMedCrossRef Shankar VG, Srinivasan K, Sistla SC, Jagdish S (2010) Prophylactic antibiotics in open mesh repair of inguinal hernia—a randomized controlled trial. Int J Surg 8:444–447PubMedCrossRef
27.
go back to reference Glassow F (1964) Is postoperative wound infection following simple inguinal herniorrhaphy a predisposing cause of recurrent hernia? Can Med Assoc J 91:870–871PubMed Glassow F (1964) Is postoperative wound infection following simple inguinal herniorrhaphy a predisposing cause of recurrent hernia? Can Med Assoc J 91:870–871PubMed
28.
go back to reference Gilbert AI, Felton LL (1993) Infection in inguinal hernia repair considering biomaterials and antibiotics. Surg Gynecol Obstet 177:126–130PubMed Gilbert AI, Felton LL (1993) Infection in inguinal hernia repair considering biomaterials and antibiotics. Surg Gynecol Obstet 177:126–130PubMed
29.
go back to reference Kaafarani HM, Kaufman D, Reda D, Itani KM (2010) Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy. J Surg Res 163:229–234PubMedCrossRef Kaafarani HM, Kaufman D, Reda D, Itani KM (2010) Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy. J Surg Res 163:229–234PubMedCrossRef
30.
go back to reference Ranaboldo CJ, Karran SE, Bailey IS, Karran SJ (1993) Antimicrobial prophylaxis in ‘clean’ surgery: hernia repair. J Antimicrob Chemother 31:35–41PubMed Ranaboldo CJ, Karran SE, Bailey IS, Karran SJ (1993) Antimicrobial prophylaxis in ‘clean’ surgery: hernia repair. J Antimicrob Chemother 31:35–41PubMed
31.
go back to reference Sanderson PJ (1999) Assessing the role of prophylactic antibiotics in clean surgery. J Hosp Infect 42:7–9PubMedCrossRef Sanderson PJ (1999) Assessing the role of prophylactic antibiotics in clean surgery. J Hosp Infect 42:7–9PubMedCrossRef
32.
go back to reference Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP (2006) 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 93:5–10PubMedCrossRef Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP (2006) 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 93:5–10PubMedCrossRef
33.
go back to reference Kark AE, Kurzer MN, Belsham PA (1998) Three thousand one hundred seventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia. J Am Coll Surg 186:447–456PubMedCrossRef Kark AE, Kurzer MN, Belsham PA (1998) Three thousand one hundred seventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia. J Am Coll Surg 186:447–456PubMedCrossRef
Metadata
Title
Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center
Authors
Z. Ergul
M. Akinci
C. Ugurlu
H. Kulacoglu
K. B. Yilmaz
Publication date
01-04-2012
Publisher
Springer-Verlag
Published in
Hernia / Issue 2/2012
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-011-0881-2

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