King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Consultant of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Senior Epidemiologist, National Center for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia.
Eur Surg Res. 2021;62(3):121-133. doi: 10.1159/000517404. Epub 2021 Aug 17.
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.
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.
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.
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.
在疝修补术后预防手术部位感染（SSI）方面，抗生素预防（AP）的作用存在争议。我们进行了这项系统评价和荟萃分析，以评估预防性抗生素在降低开放式疝修补术后 SSI 风险方面的价值。
我们在线和手动搜索，以确定比较接受开放式外科疝修补术的患者中预防性抗生素与非抗生素对照的随机对照试验。使用 RevMan 软件提取并汇总 SSI 风险数据，并以风险比（RR）和 95%置信区间（95%CI）表示。我们进一步使用 Cochrane 偏倚风险工具和 GRADE 评估来评估生成证据的质量。
目前的分析纳入了 29 项研究（N=8616 名患者）。抗生素预防可降低开放式疝修补术患者 SSI 的风险（RR=0.65，95%CI=0.53，0.79）。亚组分析表明，抗生素在网片修补患者中具有显著益处（RR=0.60，95%CI=0.48，0.76），但在疝修补术后 SSI 风险方面无显著差异（RR=0.86，95%CI=0.54，1.36）。此外，AP 与降低浅表性 SSI 风险（RR=0.56，95%CI=0.43，0.72）显著相关，但与深部 SSI 无关（RR=0.70，95%CI=0.30，1.62）。进一步分析表明，使用阿莫西林/克拉维酸和头孢唑林可显著降低 SSI 风险，但使用头孢呋辛则不然。
本荟萃分析表明，AP 在前开网片疝修补术之前是有益的。然而，证据质量较低，需要进一步设计良好的试验。
