Sanchez-Manuel F J, Seco-Gil J L
Victoria Balfé, 2 - 6 masculine B, Burgos, Castilla y León, Spain.
Cochrane Database Syst Rev. 2003(2):CD003769. doi: 10.1002/14651858.CD003769.
The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area.
The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair.
Searches in the Cochrane Colorectal Cancer Group specialized register were conducted crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot*, as free text and MeSH terms. A similar search in Medline (WebSPIRS from Silver Platter, January/1966 to November/2002) and Embase (1976 to December/2002) were conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies.
Only randomized clinical trials were included.
Seven randomized clinical trials were identified. Two of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis.
The total number of patients included was 2660 (treatment group: 1297, control group: 1363). Overall infection rates were 3.08% and 4.69% in the prophylaxis and control groups, respectively (OR 0.61, 95%CI 0.32 - 1.17). The number of patients who need to be treated with prophylaxis (NNT) to prevent one infection in at least 30 days was 50 (95%CI 25 to infinite). The subgroup of patients with herniorrhaphy had infection rates of 3.78% and 4.87% in the prophylaxis and control groups, respectively (OR 0.84, 95%CI 0.53 - 1.34). NNT was 100 (95%CI 34 - infinite). The subgroup of patients with hernioplasty had infection rates of 1.3% and 4.2% in the prophylaxis and control groups, respectively (OR 0.28, 95%CI 0.02 - 3.14). NNT is 25 (IC95% NNH 25 to NNT 8).
REVIEWER'S CONCLUSIONS: Based on the results of this meta-analysis, there was no clear evidence that routine administration of antibiotic prophylaxis for elective inguinal hernia repair reduced infection rates.
鉴于该领域研究结果存在差异，目前疝修补术中使用抗生素预防是一个有争议的问题。
本系统评价的目的是阐明抗生素预防在降低择期开放性腹股沟疝修补术后伤口感染率方面的有效性。
在Cochrane结直肠癌组专业注册库中进行检索，将术语“herni*”和“inguinal”或“groin”以及术语“antimicr*”或“antibiot*”作为自由文本和医学主题词进行交叉检索。在Medline（Silver Platter公司的WebSPIRS，1966年1月至2002年11月）和Embase（1976年至2002年12月）中使用以下术语进行类似检索：#1抗生素或抗菌或抗感染或抗传染；#2预防或防止；#3 #1和#2；#4清洁的且（手术或技术或程序）；#5疝*；#6（伤口感染）和#4；#7 #3和（#4或#5或#6）。检查纳入研究的参考文献列表以识别其他研究。
仅纳入随机临床试验。
确定了7项随机临床试验。其中2项使用人工材料进行疝修补（疝成形术），而其余研究未使用（疝修补术）。根据是否使用人工材料进行汇总分析和亚组分析。分析中使用随机效应模型。
纳入的患者总数为2660例（治疗组：1297例，对照组：1363例）。预防组和对照组的总体感染率分别为3.08%和4.69%（比值比0.61，95%可信区间0.32 - 1.17）。为预防至少30天内发生1例感染而需要接受预防治疗的患者数量（NNT）为50例（95%可信区间25至无穷大）。疝修补术患者亚组中，预防组和对照组的感染率分别为3.78%和4.87%（比值比0.84，95%可信区间0.53 - 1.34）。NNT为100例（95%可信区间34至无穷大）。疝成形术患者亚组中，预防组和对照组的感染率分别为1.3%和4.2%（比值比0.28，95%可信区间0.02 - 3.14）。NNT为25例（95%可信区间NNH 25至NNT 8）。
基于该荟萃分析的结果，没有明确证据表明择期腹股沟疝修补术常规使用抗生素预防可降低感染率。
